COMMENT DUE DATE:
February 1, 2013
DATE:
January 4, 2013
Laura Brown, AFS (405) 521-4396
Pat McCracken, OIRP (405) 522-1017
Dena Thayer, OIRP Programs Administrator (405) 521-4326
RE:
APA WF 12-16
The proposed policy is Permanent . This proposal is subject to the Administrative Procedures Act
The proposed policy is permanent and the proposed effective date is June 1, 2013.
CHAPTER 5. ADULT PROTECTIVE SERVICES
Subchapter 1. General Provisions
OAC 340:5-1-3 [AMENDED]
OAC 340:5-1-8 [AMENDED]
Subchapter 3. Reports of Maltreatment of Vulnerable Adults
OAC 340:5-3-4 [AMENDED]
OAC 340: 5-3-6 [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]
(Reference APA WF 12-16)
SUMMARY:
The proposed revisions to Subchapter 1 of Chapter 5 amend the rules to: change the division name and line of authority staff titles due to the reorganization of the Oklahoma Department of Human Services (OKDHS).
The proposed revisions to Subchapter 3 of Chapter 5 amend the rules to: (1) change the division name due to the reorganization of OKDHS; and (2) update terminology.
The proposed revisions to Subchapter 5 of Chapter 5 amend the rules to: (1) change timely completion of Adult Protective Services (APS) investigative reports for self-neglect referrals from 30 to 60 calendar days; (2) change the division name, line of authority staff titles, and terminology due to the reorganization of OKDHS; and (3) add a notification requirement upon substantiated findings involving an administrator of a facility.
SUBSTANTIVE CHANGES:
OAC 340:5-1-3, OAC 340:5-1-8, and OAC 340:5-5-6 are revised to update the division name and line of authority staff titles due to agency reorganization.
OAC 340:5-3-4 is revised to update the division name due to agency reorganization.
OAC 340:5-3-6 and OAC 340:5-5-4 are revised to update terminology due to reorganization of OKDHS.
OAC 340:5-5-3 is revised to: (1) change timely completion of APS investigative reports for self-neglect referrals from 30 to 60 calendar days to allow staff more time to provide services to the clients; and (2) change the division name, line of authority staff titles, and terminology due to OKDHS reorganization.
OAC 340:5-5-4 is revised to add notification requirement to the Oklahoma State Board of Examiners upon substantiated findings involving an administrator of a facility.
PERMANENT RULEMAKING APPROVAL IS REQUESTED.
LEGAL AUTHORITY:Director of Human Services; Section 162 of Title 56 of the Oklahoma Statutes; and Sections 10-105 and 10-108 of Title 43A of the Oklahoma Statutes.
Rule Impact Statement
To:Dena Thayer, Programs Administrator
Office of Intergovernmental Relations and Policy
From:Jim Struby
Adult and Family Services Director
Date:January 3, 2013
Re:CHAPTER 5. ADULT PROTECTIVE SERVICES
Subchapter 1. General Provisions
OAC 340:5-1-3 [AMENDED]
OAC 340:5-1-8 [AMENDED]
Subchapter 3. Reports of Maltreatment of Vulnerable Adults
OAC 340:5-3-4 [AMENDED]
OAC 340: 5-3-6 [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]
(Reference APA WF 12-16)
Contact:Laura Brown 405-521-4396
A.Brief description of the purpose of the proposed rule:
Purpose.The proposed revisions to Subchapter 1 of Chapter 5 amend the rules to: change the division name and line of authority staff titles due to the reorganization of the Oklahoma Department of Human Services (OKDHS).
The proposed revisions to Subchapter 3 of Chapter 5 amend the rules to: (1) change the division name due to the reorganization of OKDHS; and (2) update terminology.
The proposed revisions to Subchapter 5 of Chapter 5 amend the rules to: (1) change timely completion of Adult Protective Services (APS) investigative reports for self-neglect referrals from 30 to 60 calendar days; (2) change the division name, line of authority staff titles, and terminology due to the reorganization of OKDHS; and (3) add a notification requirement upon substantiated findings involving an administrator of a facility.
Strategic Plan impact. The proposed rule change will continue to achieve OKDHS goals by protecting vulnerable adults from abuse, neglect, and exploitation.
Substantive changes.
OAC 340:5-1-3, OAC 340:5-1-8, and OAC 340:5-5-6 are revised to update the division name and line of authority staff titles due to agency reorganization.
OAC 340:5-3-4 is revised to update the division name due to agency reorganization.
OAC 340:5-3-6 and OAC 340:5-5-4 are revised to update terminology due to reorganization of OKDHS.
OAC 340:5-5-3 is revised to: (1) change timely completion of APS investigative reports for self-neglect referrals from 30 to 60 calendar days to allow staff more time to provide services to the clients; and (2) change the division name, line of authority staff titles, and terminology due to OKDHS reorganization.
OAC 340:5-5-4 is revised to add notification requirement to the Oklahoma State Board of Examiners upon substantiated findings involving an administrator of a facility.
Reasons. The proposed revisions clarify language used in the agency reorganization and the line of authority in the APS regions.Increasing the time allowed for completion of self-neglect referrals allows staff more time to provide services for these clients and may reduce repeated referrals on the same individual.
Repercussions. If the proposed revisions regarding line of authority staff titles are not made, staff may be confused regarding line of authority issues.If the proposed revision to increase completion time for self-neglect referrals is not made, it may hinder APS staff's ability to reduce repeated referrals for these individuals.
Legal authority. Director of Human Services; Section 162 of Title 56 of the Oklahoma Statutes; and Sections 10-105 and 10-108 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:The classes of persons most likely to be affected by the proposed rules are Oklahoma’s vulnerable adults and OKDHS staff. The affected classes of persons will bear no costs associated with implementation of the rules.
C.A description of the classes of persons who will benefit from the proposed rule: The classes of persons who will benefit are Oklahoma’s vulnerable adults and OKDHS staff.
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 fee change: The revised rules do not have an economic impact on the affected entities. There are no fee changes associated with the revised rules.
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 probable cost to OKDHS includes the cost of printing and distributing the rules, which is estimated to be less than $20 and is within the current budget.
F.A determination whether implementation of the proposed rule will have an impact on any political subdivisions or require their cooperation in implementing or enforcing the rule: The proposed rules do not have an economic impact on any political subdivision, nor will the cooperation of any political subdivisions be required in implementation or enforcement of the rules.
G.A determination whether implementation of the proposed rule will have an adverse economic effect on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act: There are no anticipated adverse effects on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act.
H.An explanation of the measures the Agency has taken to minimize compliance costs and a determination whether there are less costly or nonregulatory methods or less intrusive methods for achieving the purpose of the proposed rule: There are no less costly or nonregulatory methods or less intrusive methods for complying with.
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: Implementation of the proposed rules gives a clear understanding of the name changes in the reorganization of OKDHS and informs staff the line of communication within the Adult and Family Services, APS unit. The 60 day investigations will improve timeliness of investigations and will reduce safety risks to vulnerable adults.
J.A determination of any detrimental effect on the public health, safety, and environment if the proposed rule is not implemented:Failure to implement the proposed rules, may affect the APS specialist’s ability to provide the most appropriate protective services.
K.The date the rule impact statement was prepared and, if modified, the date modified: Prepared October 25, 2012 and modified December 4, 2012.
SUBCHAPTER 1. GENERAL PROVISIONS
340:5-1-3. Program coordination
Revised 6-1-10 6-1-13
Adult and Family Support Services Division, Adult Protective Services (APS) Unit, has responsibility for program planning, staff training, technical assistance, quality assurance, and policy development.Field Operations Division, area APS program field representatives (PFR)s district supervisors assist in this process by providing local support for APS staff.The APS program is implemented in the field through APS specialists in local Oklahoma Department of Human Services offices.¢ 1
INSTRUCTIONS TO STAFF 340:5-1-3
Revised 6-1-10 6-1-13
1.(a) Questions When the Adult Protective Services (APS) specialist has questions concerning policy issues, are addressed by the Adult Protective Services (APS) specialist to he or she consults with the APS specialist IV for resolution.If the APS specialist IV is unavailable to answer these questions, staff may consult the area APS program field representative (PFR) district director.Adult and Family Support Services (AFS) Division (FSSD), APS Unit staff address questions concerning policy, procedures, and protocols if neither the APS specialist IV nor the area and APS PFR is available district director are unavailable, and in all cases serves as the final authority for interpreting APS program policy.
(b) All personnel issues are the responsibility of the county APS district directors are responsible for all personnel issues.
(c) County directors are responsible for day-to-day administrative issues involving APS staff housed in their county offices.
(b)(d) Questions regarding legal issues may be referred to the Oklahoma Department of Human Services (OKDHS) Office of General Counsel by FSSD AFS, APS Unit staff or the APS area PFRs district director.In emergency situations involving temporary guardianships the APS specialist IV may refer the APS specialist directly to the Office of General Counsel.
(c)(e) In cases where When an APS specialist is subpoenaed to testify in court regarding an APS case, receives an order to release information, or receives an order to testify at a deposition, the APS specialist, following consultation with the APS specialist IV:
(1) contacts the Office of General Counsel to review what information may be divulged;
(2) faxes or scans and e-mails emails a copy of the subpoena or order to the OKDHS Office of General Counsel before any other contact is made; and
(3) documents contact with the Office of General Counsel in the Notes Section of the APS Computer System.
340:5-1-8. Complaints concerning the APS program
Revised 6-1-10 6-1-13
Complaints regarding an investigation or the provision of services may be submitted to the Oklahoma Department of Human Services (OKDHS) by telephone or in written form, including e-mail email.Complaints regarding:
(1) Adult Protective Services (APS) policy and procedure are referred to the county district director who performs a case review. The county district director sends a written response to the complainant within 45 calendar days stating the general findings of the review.If not satisfied with the county district director's findings, the complainant may, within 30 calendar days of the date of the letter, submit a written appeal to the, OKDHS Adult and Family Support Services Division (AFS), APS Unit, P. O. PO Box 25352, Oklahoma City, OK 73125.A committee composed of Family Support Services Division and Field Operations Division AFS staff reviews the appeal and sends the complainant its the decision within 30 calendar days;¢ 1
(2) possible inappropriate treatment conduct by an APS specialist or APS specialist IV are referred to the appropriate county district director for action; and¢ 2
(3) involuntary services are handled through the appropriate judicial system.¢ 3
INSTRUCTIONS TO STAFF 340:5-1-8
Revised 6-1-10 6-1-13
1.(a) No confidential information is included in the letter.A copy of the letter is also sent to the Adult and Family Support Services Division (FSSD) (AFS) Adult Protective Services (APS) Unit.
(b) The division directors for FSSD and the Field Operations Division (FOD) appoint staff to serve on the appeal AFS APS field administrator and APS unit programs manager review committee the appeal.Upon reaching a decision, the APS unit programs manager prepares a response letter.is prepared for either the FOD or FSSD director signature depending on the nature of the complaint After review and signature by the APS deputy director, the response letter is sent to the complainant.
2.(a) When a civil rights allegation is received, the county director offers to help the complainant complete Form 14CR001E, Discrimination Complaint – Client or Vendor.The completed form is sent to the Office for Civil Rights at the address on the form for appropriate action.
(b) The county director of the human services center (HSC) in APS specialist IV assigned to the county in which the alleged victim resides is responsible for addressing the complaint of possible inappropriate conduct by an APS specialist.
(c) The APS district director reviews all complaints of possible inappropriate conduct by APS staff.
3.The Oklahoma Department of Human Services (OKDHS) Office of General Counsel may be consulted when these complaints are received.
SUBCHAPTER 3. REPORTS OF MALTREATMENT OF VULNERABLE ADULTS
340:5-3-4.Reports under the jurisdiction of agencies other than local Adult Protective Services (APS)
Revised 7-1-12 6-1-13
Some reports of alleged maltreatment of vulnerable adults are not investigated by local Adult Protective Services (APS) staff.
(1) Reports of alleged victims who are residents of Northern Oklahoma Resource Center of Enid (NORCE), Robert M. Greer Center (Greer), or Southern Oklahoma Resource Center (SORC) of Pauls Valley, or former residents of Hissom Memorial Center.APS staff refer reports that allege a current resident of NORCE, Greer Center, or SORC has suffered maltreatment by an employee of the facility or maltreatment of a former resident of Hissom Memorial Center by a current caretaker to the Oklahoma Department of Human Services (OKDHS) Office of Client Advocacy (OCA).¢ 1
(2) Reports of maltreatment by persons providing services to alleged victims receiving services from a community services worker, a community services provider, a SoonerCare (Medicaid) personal care services provider, a or Medicaid personal care assistant (MPCA).APS staff refer reports to the OKDHS OCA when the alleged victim receives services from a community services worker, a community services provider, a SoonerCare (Medicaid) personal care services provider, or a MPCA, as those terms are defined in Section 1025.1 of Title 56 of the Oklahoma Statutes.¢ 2
(3) Alleged victims of maltreatment in hospital settings.APS staff refer refers reports of alleged maltreatment of vulnerable adults who are receiving services in medical hospitals, rehabilitation facilities, or private psychiatric hospitals by staff of the facility to the Oklahoma State Department of Health (OSDH), Protective Health Services, Medical Facilities Service.¢ 3
(4) Alleged victims of maltreatment by staff of the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) and its contracted providers.APS staff refer reports of alleged maltreatment of a vulnerable adult by staff of a public or private community mental health agency to the Advocacy Division of ODMHSAS.If ODMHSAS declines to conduct an investigation, the report may be referred back to the local APS office.¢ 4
(5) Reports alleging maltreatment of residents by staff of nursing facilities.APS staff send reports of alleged maltreatment of nursing facility residents to the Adult and Family Support Services Division (AFS), APS Unit, Long Term Care Investigations Section.These reports are also sent to the OSDH, Protective Health Services.¢ 5
(6) Reports involving local, state, or federal correctional facilities.APS staff refer reports of abuse, neglect, or exploitation of residents by staff of state or federal public hospitals, jails, prisons, or similar facilities to the facility's regulatory department for investigation and to the local district attorney.
(7) Reports involving deceased alleged victims.Reports of maltreatment of persons who are already deceased at the time the report is made are not accepted by APS.Reporters are referred to the state or local Office of the Medical Examiner, local law enforcement, or, if the death occurred in a nursing facility, to the Medicaid Fraud Control Unit in the Office of the Attorney General.¢ 6
INSTRUCTIONS TO STAFF 340:5-3-4
Revised 7-1-12 6-1-13
1.(a) When the Adult Protective Services (APS) specialist receives a report regarding current residents of Northern Oklahoma Resource Center of Enid (NORCE), 580-213-2700, the Robert M. Greer Center (Greer), 580-213-2700, Southern Oklahoma Resource Center (SORC), 405-238-6400, or a former resident of Hissom Memorial Center (Hissom), he or she enters all pertinent information in the Intake Section of the APS computer system and immediately refers the report to the Office of Client Advocacy (OCA) by fax 405-525-4885 or email emails *oca.intake@OKDHS.org.
(b) In some instances of self-neglect involving Hissom class members, the OCA may return the complaint to the local APS staff for the human services center (HSC) county office where the alleged victim (AV) resides.
2. (a) APS specialists refer reports of maltreatment when the AV receives services from a community services worker, a community services provider, a SoonerCare (Medicaid) personal care services provider, or a Medicaid personal care assistant, by entering all pertinent information in the Intake Section of the APS computer system and submits the report to the appropriate APS specialist IV for screening.
(b) After screening, the APS specialist IV immediately refers the report to OCA by:
(1) faxing it to 405-525-4885; or
(2) emailing a computer screenshot of the intake report to *oca.intake@okdhs.org.
3.The APS specialist IV calls the Oklahoma State Department of Health (OSDH), Protective Health Services, Medical Facilities Service at 405-271-6576 to report maltreatment of vulnerable adults in hospital settings.The APS specialist IV documents the referral was made to OSDH in the IR Notes section of the APS computer system.
4.The APS specialist IV calls the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) Advocacy Division at 405-573-6605 405-521-4256 or toll free, 1‑866-699-6605 1-877-699-6605 to report alleged maltreatment of the vulnerable adult by staff of a facility operated by or contracted from ODMHSAS.The APS specialist IV documents the referral was made to ODMHSAS in the IR Notes section of the APS computer system.
5.When HSC county staff receives a report of maltreatment of a nursing facility resident, he or she enters all pertinent information in the Intake Section on the APS Computer System and marks it as a facility investigation.The system automatically submits the report to the Long Term Care Investigations (LTCI) Unit for screening.The LTCI telephone number is 405-521-3440; fax 405-522-3463.
6.When the APS specialist conducted a face-to-face interview with the AV and the AV dies during the investigation, the APS specialist continues with the elements of the investigation to complete the investigation.
340:5-3-6. Screening APS reports
Revised 6-1-10 6-1-13
(a) Time frame for screening Adult Protective Services (APS) reports.APS specialist IVs are responsible for screening new reports on the APS Computer System on a regular basis throughout the day to identify emergency situations and to ensure assignment to the correct human services center (HSC) county office.
(b) Responsibility for screening reports.APS specialist IVs are responsible for screening reports and either accepting them as APS referrals or classifying them as Information and Referral.When a request is accepted as an APS referral, the APS specialist IV determines whether an emergency response is indicated, whether if the referral is employee related, and which APS specialist is assigned the referral.APS specialist IVs complete screening in a manner to facilitate the timely initiation of the investigation as defined in per OAC 340:5-5-2.¢ 1
(c) Reports involving domestic violence.APS situations are often forms of domestic violence.Reports received alleging maltreatment of an adult by a spouse or other family or household member are considered protective services requests if when the alleged victim is vulnerable as defined in per OAC 340:5-1-6.¢ 2
(d) Reports involving OKDHS employees or their families.Specific procedures are followed when a report of maltreatment is received which that involves an employee of the Oklahoma Department of Human Services (OKDHS) employees.¢ 3
INSTRUCTIONS TO STAFF 340:5-3-6
Revised 11-1-11 6-1-13
1.(a) The Adult Protective Services (APS) specialist IV uses the items in (1) through (6) of this Instruction as screening criteria for reports.
(1) Is the alleged victim (AV) of maltreatment reported to be a vulnerable adult?
(2) Does the situation described potentially fall into one of the categories of abandonment, abuse, financial neglect, neglect, self-neglect, exploitation, sexual abuse, sexual exploitation, or verbal abuse?
(3) Does the setting where the maltreatment is alleged to have occurred fall into the jurisdiction of the community APS program?
(4) Does the situation as reported appear to potentially require emergency intervention?
(5) The APS specialist IV determines whether the situation presents a potential, immediate threat to the APS specialist or vulnerable adult.If a potential threat exists, the APS specialist IV or APS specialist contacts emergency personnel.Emergency personnel may precede or accompany the APS specialist to the home.APS specialists are not first responders and do not knowingly insert themselves into dangerous situations.APS specialists may receive additional information from emergency personnel or discover situations requiring emergency personnel at the initial home visit and may facilitate the provision of needed services as appropriate.
(6) When a report is not accepted for APS investigation, the APS specialist refers the reporter to other agencies that may provide assistance.The APS specialist documents the contact as an Information and Referral (I & R) in the APS Computer System I & R Notes Section and states reasons the report did not meet the criteria for investigation.
(b) If there is insufficient information in the report to immediately determine the AV meets the definition of vulnerable adult, the APS specialist IV attempts to determine vulnerability.
(1) Information on the Oklahoma Department of Human Services (OKDHS) computer system may be viewed, and the APS specialist IV may contact the reporter for additional information, to assist in this determination.APS specialist IVs must be familiar with the definition of vulnerable adult, and remember that it is not necessary to have a formal disability determination of disability to consider an adult vulnerable.
(2) Unless it is clear that the AV is not a vulnerable adult, the report may not be screened to I & R solely based on lack of vulnerability.
(c) The APS specialist IV considers the definitions of the types of maltreatment.If the alleged situation fits at least one of the definitions of maltreatment, it is accepted for investigation.If the situation does not fit one of the definitions, the report is screened as I & R, the APS specialist IV documents in the Notes Section why the report was screened as I & R, and the reporter, if known, is contacted to discuss other alternatives for handling the issue.
(d) If a report contains allegations of serious problems that could result in death or serious physical harm to the AV, the report is screened as requiring immediate action, and is immediately communicated to the assigned APS specialist.In case of these emergencies, APS specialists are required to carry agency issued cell phones at all times.
(e) If the setting is not in a jurisdiction APS investigates, as described in per OAC 340:5-3-4, the APS specialist advises the reporter, when known, of the name of the agency to which APS will forward the report.
2.APS specialists are familiar with the provisions of the Protection from Domestic Abuse Act, Sections 60 through 60.18 of Title 22 of the Oklahoma Statutes (22 O.S. §§ 60 - 60.18), the Domestic Abuse Reporting Act, 22 O.S. §§ 40.5 through 40.7, and 74 O.S. § 150.12.B.
(1) In cases where the AV does not meet the APS definition of vulnerable adult, the APS specialist refers the AV to the local court clerk or other appropriate service provider for assistance in obtaining legal advice, action, or both, and services.
(2) If the report includes an allegation of abuse or neglect of a person younger than 18 years of age, the APS specialist immediately makes a referral to Child Protective Welfare Services (CPS)(CWS), and coordinates the investigation with the Children and Family Services Division (CFSD) worker child welfare specialist.
3.(a) Additional screening criteria apply upon receipt of a report involving OKDHS employees or their immediate or extended family members to help determine if the potential for conflict of interest exists with the AV or alleged perpetrator (AP).It is never appropriate for anyone to discuss the report with the involved employee outside of the investigative process.Notifying an employee of a pending investigation is a violation of the confidentiality provisions of 43A O.S. § 10-110.In addition to the basic screening criteria, the APS specialist IV determines:
(1) the relationship of the AV to the OKDHS employee;
(2) whether the employee is the AP; and
(3) the extent of any involvement between the employee and local APS specialists, including the APS specialist IV.
(b) After thoroughly analyzing the additional screening criteria, the APS specialist IV, county director, and area APS program field representative (PFR) district director, determine whether the potential for conflict of interest or the appearance thereof may exist if the report is assigned for investigation to local staff.
(1) The potential for conflict of interest may be determined to exist if, through acquaintance with the employee, the APS specialist or APS specialist IV could possibly be accused of favoring the employee's wishes or benefiting the employee in any way through the investigation.
(2) In some cases in which the employee is a family member, but not an AP or actively involved in the care of the AV, there may be no question of conflict of interest and the referral may be investigated without being transferred.
(c) If the potential for conflict of interest exists, the APS PFR district director coordinates with the county director to assign assignment of the referral to a different APS specialist IV group.If an out-of-area district assignment of the report is necessary, the area district director or designee coordinates and field administrator coordinate the action with the other involved area district director or designee as well as county directors of the sending and receiving human services centers (HSCs).The Adult and Family Support Services (AFS) Division (FSSD) APS Unit, may be consulted at any time in determining the appropriate disposition of a report involving an OKDHS employee.After a decision is reached regarding assignment of the report, the involved county directors are notified, as well as the APS specialist IV for the receiving HSC.
(1) Out-of-group assignment is appropriate when the local employee who is involved in the report is not well known to other APS staff in the area district.
(2) Out-of- area Out-of-district assignment is appropriate when the local employee involved in the report is well known over a large portion of the area district, and APS staff in the area district could not investigate without the potential appearance of conflict of interest.
(d) If the allegation involves possible violations of the employee's professional position, a recommendation is made to refer the report to the Office of Inspector General (OIG) of OKDHS on Form 19MP001E, Referral Form, or the electronic equivalent.If accepted by OIG, local staff cooperate as requested.If OIG declines, the area director field administrator or designee follows the procedure for assigning a complaint that involves involving an employee.
(e) Per OAC 340:5-3-2(c) 340:5-3-2 Instructions to staff (ITS) # 1(c), in an emergency situation requiring an immediate response, HSC assigned county staff from the office where the alleged victim resides resolves the emergency and then follows the procedure to have the case reassigned reassign the case to staff in a different HSC county office if necessary.
(f) The APS specialist IV notifies the area district director immediately of substantiated referrals in which the employee is named as perpetrator, and also notifies FSSD AFS, APS Unit, of any training issues that are identified as a result of the findings.
(g) Refer to OKDHS:115-3-2(e)(5) for rules regarding the county director's responsibility as the custodian of records for the human services center (HSC) county office and when the employee and county director must complete Form 08AD042E, Securing and Assigning Sensitive Case Records.
(1) Paper case records on APS investigations involving OKDHS employees are maintained in the locked executive files section of the local office.
(2) Electronic records are appropriately coded for confidentiality by the APS specialist IV during the screening process in the APS Computer System to restrict who has access to these records.
SUBCHAPTER 5. INVESTIGATION OF ADULT PROTECTIVE SERVICES REFERRALS
340:5-5-3. Elements of an investigation
Revised 6-1-10 6-1-13
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 alleged victim's (AV's) caretaker, guardian, and next of kin.¢ 2
(3) Visits to and interviews with the vulnerable adult.As mandated by Section 10-105(C)(1)(a) of Title 43A of the Oklahoma Statutes (43A O.S. § 10-105(C)(1)(a)) 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.The APS specialist interviews other people who have or can reasonably be expected to have pertinent knowledge about the AV's circumstances during the investigation, including any alleged perpetrator (AP) of maltreatment.¢ 4
(A) 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.
(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 43A O.S. § 10-106(C) to determine a vulnerable adult's risk and needs along with the vulnerable adult'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 when available, to assist in the determination.In making this the determination, the APS specialist assesses and considers:
(i) the vulnerable adult's short and long term memory;
(ii) the vulnerable adult's executive functioning by their his or her ability to plan and execute a plan;
(iii) the vulnerable adult's ability to recognize risk factors;
(iv) denial of problems by the vulnerable adult or caretaker;
(v) the vulnerable adult's executive functioning by his or her 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 vulnerable adult's mental capacity to consent to protective services takes into account the vulnerable adult's awareness of the:
(i) the limitations and deficiencies in the physical environment;
(ii) the vulnerable adult's own physical or mental limitations;
(iii) resources available to assist in meeting the vulnerable adult's needs; and
(iv) the consequences to the vulnerable adult if nothing is done to improve the situation.
(C) If a vulnerable adult 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 vulnerable adult expresses awareness of all four areas in (B) of this paragraph, it is likely that the present circumstances are the vulnerable adult's choice, though in some cases a vulnerable adult might express awareness in these areas and still lack the capacity to consent to provision of services.
(E) If a vulnerable adult 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 APS specialist IV 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 to include 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;
(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.¢ 5
(9) Completion of investigative report.From the date an APS referral is received, the APS specialist completes the investigative report within 30 calendar days for self neglect referrals and 60 calendar days for referrals involving an AP.The APS specialist IV may extend the time frame for completion of an investigation for an additional 30 calendar day period when it is in the vulnerable adult's best interest to do so.¢ 6To complete the investigation, the APS specialist:
(A) completes necessary interviews and assessments including identification of any immediate service needs;
(B) completes all final documentation;
(C) submits a report to the local district attorney; and
(D) makes a determination of substantiated or unsubstantiated based on the definitions of terms in OAC 340:5-1-6.¢ 7
(10) Findings.The APS specialist, in conjunction with the APS specialist IV, makes a final determination of the investigative process on each allegation contained in the APS referral.Each allegation is determined to be substantiated or unsubstantiated and the investigation documented in accordance with per OAC 340:5-5-5.The APS specialist IV notifies the appropriate area district director and the APS field administrator immediately of substantiated referrals in which an OKDHS employee is named as perpetrator.
(11) Follow-up.The APS specialist, in consultation with the APS specialist IV, 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.¢ 8
(B) For referrals that resulted in a vulnerable adult receiving involuntary services, OKDHS is responsible for 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 vulnerable adult.At least one follow‑up visit is made at 30 calendar days regardless of whether OKDHS continues to hold temporary guardianship.
(i) If the vulnerable adult's situation is stable or improving after 30 calendar days and OKDHS no longer holds guardianship, the case is closed.
(ii) If OKDHS continues to hold guardianship after 30 calendar days, a follow-up visit to the vulnerable adult is required at least once each 30 calendar days for the duration of the temporary guardianship.
(iii) If the vulnerable adult'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 vulnerable adults receiving involuntary services are made at least every 30 calendar days, but may be made as often as needed to comply with APS specialist guardianship responsibilities and to monitor the vulnerable adult'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 vulnerable adult for the duration of the court ordered temporary guardianship.The frequency of this contact is determined by the APS specialist and APS specialist IV's determination of the specific situation and the availability of an independent objective third party to provide follow-up and notification to the APS specialist.The APS specialist visits the vulnerable adult at least once every 30 calendar days while the vulnerable adult is under APS guardianship.The APS specialist documents information from follow-up visits in the APS Computer System and makes it available to the court on review of the guardianship.Follow-up visits may be made as frequently as the APS specialist and specialist IV determine they are needed, based on an individual vulnerable adult's situation.¢ 8For vulnerable adults placed:
(I) in medical facilities, such as geriatric psychiatric units or medical hospital for care, the worker follows-up with the vulnerable adult'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 vulnerable adult for follow‑up information every 30 calendar days or more often as indicated;
(III) at any facility owned or operated by OKDHS, the APS specialist makes face-to-face visits 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 vulnerable adult, at least once every two weeks during the first month of placement to check for changes in the vulnerable adult's condition, such as injuries, signs of over‑medication, and cognitive state.The APS specialist discusses concerns with the nursing home administrator or director of nursing, and the APS specialist IV.After the first month, the APS specialist visits the vulnerable adult at least once every 30 calendar days, reviews the nursing home charts and incident reports, and discusses care needs with the staff and vulnerable adult's family, if available.
(C) 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 vulnerable adult, or the facility's request to relocate the vulnerable adult.
(i) Placement alternatives are determined in accordance with this Section and approved by the specialist IV, county and the district director, and the area APS program field representative (PFR).
(ii) The court appointed attorney for the vulnerable adult and the family is notified of the problems and the alternatives that have been developed.
(iii) The APS specialist submits a written report of the change of placement to the court, with a copy of the motion to the vulnerable adult's family and attorney of record.
(D) The APS specialist makes frequent contact with vulnerable adults remaining at home in temporary guardianship at a minimum of every 30 calendar days to assure that ensure the established service plan meets vulnerable adult's safety and needs are being met by the established service plan.The APS specialist:
(i) makes modifications as needed to the service plan as well as provision of services by providers;
(ii) evaluates the quality of care and the method of contact on a case-by-case basis depending on the individual needs of the specific vulnerable adult including a face‑to‑face visit every 30 calendar days; and
(iii) submits reports at the request of the court or a minimum of every 30 calendar days.
(E) In the event the vulnerable adult is placed in a facility out-of-county, the APS specialist IV immediately contacts the APS specialist IV 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 vulnerable adult is residing is the worker specialist designated to provide follow-up services for temporary guardianship cases.¢ 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
(iii) The APS specialists and specialist IVs from both counties discuss and determine the best course of action for renewals of temporary guardianships.
(I) The decision takes into account the vulnerable adult's specific situation, the family and their desires, the availability of the courts in the two counties, and the advice of the vulnerable adult's court appointed attorney, and the attorney(s) representing OKDHS in the matter.
(II) The area APS PFR district director, FSSD Adult and Family Services (AFS) APS Unit, and attorneys for the OKDHS Office of General Counsel are consulted as needed for assistance in determining the best course of action.
INSTRUCTIONS TO STAFF 340:5-5-3
Revised 11-1-11 6-1-13
1.Each Adult Protective Services (APS) specialist IV is responsible for determining, in conjunction with each county APS district 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 vulnerable adult'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 adult's wishes.
(c) When the caretaker, guardian, and next of kin are identified, a copy of OKDHS Publication No, 99‑07, "APS Questions and Answers," is provided to each of them and to the vulnerable adult.
3.(a) All contacts are documented in the Interview Section of the APS Computer System.
(b) When there are two or more counties involved, refer to procedures in OAC 340:5-5-4(b).
(c) When the APS specialist is unable to locate the alleged victim (AV) for the initial interview per OAC 340:5-5-2, he or she makes at least three attempts to locate the AV as detailed in (1) through (3) of this Instruction.
(1) If, at the first attempt, the AV does not answer the door, the APS specialist follows the protocol in (A) through (D) prior to leaving the residence.
(A) The APS specialist attempts to contact the AV via cell phone.
(B) If no one answers the telephone, the APS specialist calls the reporter to verify correct information.
(C) If the reporter does not have additional information regarding the whereabouts of the AV, the APS specialist contacts collaterals, such as neighbors, doctors, and family to attempt to locate the AV.
(D) If attempts to locate the AV are unsuccessful, the APS specialist does not leave a business card or OKDHS Publication No. 99‑07, "APS Questions and Answers."
(2) If the first attempt was unsuccessful, the APS specialist makes a second attempt to contact the AV within three working days at a different time of the day.If the AV does not answer the door, the APS specialist follows the protocol in (A) through (C) of this Instruction prior to leaving the residence.
(A) The APS specialist attempts to contact the AV via cell phone.
(B) If no one answers the telephone, the APS specialist calls the reporter to verify correct information.
(C) If attempts to locate the AV are unsuccessful, the APS specialist leaves a business card or OKDHS Publication No. 99‑07, "APS Questions and Answers," at the residence requesting contact.
(3) If the AV does not contact the APS specialist, he or she attempts a third visit within three working days of the second attempt.If the AV does not answer the door, the APS specialist follows the protocol in (A) through (D) of this Instruction.
(A) The APS specialist mails a contact letter on OKDHS letterhead to the last known address requesting the AV contact the APS specialist within seven calendar days.
(B) If the letter is returned undeliverable or there is no response within seven calendar days, the APS specialist staffs the referral with the APS specialist IV regarding further options and documents in the Notes Section, what further action, if any, is planned.
(C) When the APS specialist and the APS specialist IV decide that all reasonable efforts to locate the AV have been made, the APS specialist documents the referral as unsubstantiated based on "unable to locate."
(D) When the reporter is from a law enforcement agency and the APS specialist is unable to locate the AV, the APS specialist contacts and notifies the reporter.When the reporter is from another state or local agency and the APS specialist is unable to locate the AV, the APS specialist notifies that agency and local law enforcement.
4.Interviews with collateral contacts are extremely important in helping the APS specialist determine the AV's current circumstances, expressed desires, habitual practices, and recent changes.The APS specialist documents all interviews with collaterals, alleged perpetrators (APs), family members, next of kin, caretakers, legal guardians, or service providers in the Interview Section of the APS Computer System.
(1) The AV's caretaker, guardian, next of kin, and the reporter are considered collateral contacts if when they are identified.
(2) Any collateral contacts about which the APS specialist is unsure are staffed with the APS specialist IV before the APS specialist interviews the collateral contact.
(3) The AP is interviewed in all referrals in which a perpetrator is identified.The AP is interviewed after other contacts have been are 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 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) The APS specialist documents all collateral contacts and attempts at contact in the Interview Section of the APS Computer System.
5.APS specialists in each human services center (HSC) county 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 that may be helpful facilitating the investigation process or providing needed services to vulnerable adults.
6.(a) It may be in the best interest of the vulnerable adult to delay finalizing the report in order to allow the APS specialist more time to visit with the vulnerable adult to establish rapport before the vulnerable adult makes a decision about accepting available services.
(b) When the APS specialist IV, county district director, field administrator, or area director designee grants an extension, the completion of the referral is not considered delinquent for management reports.
(c) The APS specialist IV may extend the time frame for completion of the investigation for a specified time not to exceed an additional 30 calendar days when it is in the best interest of the vulnerable adult.When the APS specialist IV approves the extension request, he or she documents the approval and the reasons why the 30-day extension was granted in the Extension Request and Notes Sections of APS Computer System.
(d) The county district director must decide whether to approve the second extension request when the investigation cannot be completed within the additional 30-day time frame and documents in the Extension tab whether to extend the request based on:
(1) total number of referrals received during the previous 60 calendar day period;
(2) staff available to conduct investigations and assessments;
(3) excessive work loads.Examples of excessive work load situations include, but are not limited to:
(A) an APS specialist IV vacancy of more than one month;
(B) an APS specialist vacancy in a one worker HSC county office;
(C) an APS specialist vacancy of more than two months in any HSC county office;
(D) an increase in temporary guardianships that require intensive and immediate attention;
(E) an increase in investigations which are complicated and complex;
(F) any special duty investigations requiring staff to work in other locations; or
(G) any combination of (A) through (F); and
(4) any additional circumstances that led to the difficulty in meeting policy requirements and time frames.
(e) The area director APS field administrator must decide whether to approve the third and any subsequent extension requests when the investigation cannot be completed within the third or subsequent 30-day time frame.The area director field administrator makes the decision and documents whether to extend the request based on information provided by the county director in the Extension tab.
7.(a) This evaluation is the basis for determining a referral substantiated or unsubstantiated, and for developing an individualized service plan for the vulnerable adult.
(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 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 vulnerable adult and involved family and caretakers in all cases where service needs are indicated.
(b) The county district director is responsible for monitoring timely completion of APS investigations within 60 calendar days and regularly discussing with the APS specialist IV referrals with investigations pending over 90 calendar days.
(c) Service provision and follow-up activities often extend beyond the 60 calendar days based on the individual vulnerable adult's needs and service plan.These ongoing activities are not considered in determining whether the investigation was timely, as long as a substantiation decision was reached and Form 08AP002E was submitted to the DA's office within 10 calendar days of completing the investigation.
8.The APS specialist documents follow-up activities in the APS Computer System by completing a new risk assessment in the Risk Assessment Section, entering the date and time of the contact and information about the visit in the Service Plan Monitoring Notes Section.
(1) If the APS specialist IV and APS specialist determine no follow-up is not necessary, that the decision and the reasons for it are documented, where appropriate, in the Service Plan Notes or the Service Plan Monitoring Notes Section of the APS Computer System.
(2) If the APS specialist IV and APS specialist determine follow-up is necessary, the APS specialist documents why follow-up is necessary and the plan for completing follow-up in the Service Plan Monitoring Notes Section of the APS Computer System.
(3) The APS specialist may complete a follow-up contact by telephone rather than face-to-face with someone other than the vulnerable adult or the AP after receiving APS specialist IV approval.The APS specialist documents in the Service Plan Monitoring Notes Section:
(A) the means of contact;
(B) why the contact was made by phone rather than face-to-face; and
(C) what information was obtained.
9.In the event the vulnerable adult 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 by the APS specialist IV 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 Section of the APS Computer System.
340:5-5-4. Special considerations during investigations
Revised 7-1-12 6-1-13
(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 (43A O.S. §§ 10-101 through 10-111).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 or when the AV moves either temporarily or permanently to another county before the investigation has been completed, local APS staff from both human services centers (HSCs) county offices 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.Care providers who may be subject to APS investigation include, but are not limited to, home health providers, 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) Any corrective action plan on the part of the provider agency becomes a part of the APS case record.If the provider 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 boards, agency agencies, or registry registries.¢ 4
(f) Referrals alleging exploitation.When referrals involve large amounts of funds or the need to access complex records regarding financial transactions, the APS specialist is authorized to request assistance from the OKDHS Office of Inspector General (OIG).¢ 5If 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; ¢ 6
(2) freezing all assets of the vulnerable adult;
(3) petitioning the court for an order allowing access to records;
(4) redirecting or stopping the flow of the vulnerable adult's assets into the alleged perpetrator's accounts; and
(5) stopping perpetrator access to the alleged victim's account(s).
(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 or conditionally release the incompetent defendant according to 22 O.S. § 1175.6(b)(B).In order to qualify for such disposition, the court must make findings described in (1) or (2) of this subsection.
(1) Referral for voluntary services or conditional release occurs when the court finds that the person is incompetent for reasons other than the AV is a person requiring treatment under 43A O.S. 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 OKDHS services or conditional release 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 Developmental Disability Services Division (DDSD) Area Intake office and requests their involvement in the process of determining in consultation with the Office of General Counsel if voluntary services are available and adequate or whether to propose a plan of services for conditional release.This is a joint effort between the APS specialist and the DDSD case manager.¢ 7
(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.¢ 8
(i) Referrals involving residents of residential care facilities, assisted living facilities, and continuum of adult day care facilities.The APS specialist sends a copy of the final investigative report to OSDH. Upon completion of an investigation involving an administrator named as the alleged perpetrator and the findings are substantiated, the APS specialist IV notifies the Oklahoma State Board of Examiners for Long Term Care Administrators (OSBELTCA).¢ 9
INSTRUCTIONS TO STAFF 340:5-5-4
Revised 7-1-12 6-1-13
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. Information from an APS investigation may be shared with the Bureau of Indian Affairs (BIA) and tribal governments.
2.APS staff in the county of residence of the alleged victim (AV) has primary responsibility for 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) county office in the AV's county of residence for completion of the case.This includes, but is not limited to, interviews with collateral contacts, such as family members, alleged perpetrators (APs), or other persons determined to have knowledge pertinent to the investigation and conducting property searches, obtaining bank records, or other material pertinent to the investigation.
(1) Staff in the HSC county office of the county of residence may request APS staff in the HSC of the county in which the 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.When the back-up APS specialist interviews the AP, the back-up APS specialist documents the interview in the Interview tab of the APS Computer System within five working days.
(2) When the AV is temporarily housed in another county, the APS specialist IV in the resident county where the AV normally resides may request that the back-up specialist in the temporary county completes complete and documents document the initial face-to-face interview as quickly as possible, completes and documents the Capacity Assessment, initiates and documents the Risk and Needs Assessments, and contacts and documents any available collaterals.Staff in the resident county is responsible for completing the investigation and takes into consideration the input from the temporary county's APS specialist.The time frame for initiating the investigation remains the same per OAC 340:5-5-2.
(3) If it is determined that the AV relocated to another county prior to the conclusion of the investigation, the referral may be transferred to the new county.The APS specialist IV of the initial county contacts the APS specialist IV of the receiving county as soon as this determination is known in order to complete the investigation in a timely manner.
(4) When problems with coordination occur between APS staff in different HSCs county offices or there are delays in documenting information, HSC county APS staff contact the area APS program field representative(s) (PFR) district director 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 vulnerable adult if when approved by the area nurse;
(3) assist the APS specialist in determining a course of action on the vulnerable adult's behalf; and
(4) assist in the follow-up of the vulnerable adult 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 a nursing resource is unavailable, 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 vulnerable adult.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 vulnerable adult, 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 Nursing Assessment Section of the APS Computer System.
4.(a) Contact information for OSDH includes:
(1) mailing address, 1000 N.E. 10th Street, Oklahoma City, 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) email address, LTCComplaints@health.state.ok.gov.
(b) Contact information for the Oklahoma State Board of Nursing includes:
(1) mailing address, 2915 N. Classen Blvd., OKC, OK 73106; and
(2) telephone number, 405-962-1800.
5.The APS specialist makes the referral to OKDHS Office of Inspector General (OIG) on Form 19MP001E, Referral Form, or its electronic equivalent, and sends an email referral to oigfraud@okdhs.org.
6.A vulnerable adult's benefits may be suspended pending appointment of a payee or change of payee.
7.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 per Section 1175.6b of Title 22 of the Oklahoma Statutes (22 O.S. § 1175.6(b)).Periodic reports are made annually, or more often when court ordered.
(1) HSC Assigned county staff in the vulnerable adult's county of residence maintain the original paper case records on vulnerable adults previously remanded to OKDHS under Title 22 of the Oklahoma Statutes including copies of all reports and evaluations.The APS specialist enters new reports in the Intake Section of the APS Computer System with references to existing paper files.
(2) If the county of the vulnerable adult's residence is different from the county of court jurisdiction, an APS specialist in the county of residence is assigned as back-up for the purpose of seeing the vulnerable adult, documenting the contact, and preparing reports as needed.The reports are maintained in the specified "W" drive and may be printed as needed by the APS 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 then sets another hearing for the purpose of determining competency.
8.(a) APS staff provides information to DDSD staff to assist in evaluation of a vulnerable adult known or suspected to have a developmental disability.The case manager for a vulnerable adult 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 staff is assisted by DDSD staff 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 vulnerable adult 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, when necessary, on home visits and assist in making application for DDSD services.When DDSD staff assist APS staff on a case, APS staff route a copy of Form 08AP002E 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 vulnerable adult 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 and the toll-free number is 1‑800-522-1064;
(B) Area II includes Tulsa and the toll-free number is 1-800-522-1075; and
(C) Area III includes Pauls Valley and 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 apply.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 perpetrators, 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 waiver request 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, per OAC 317:40-1-1(g) 317:40-1-1(f).
(e) The APS specialist routes a copy of Form 08AP002E to DDSD Quality Assurance upon completion of the APS investigation involving vulnerable adults receiving DDSD services.
(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 APS specialist immediately routes the report to Office of Client Advocacy (OCA) because OCA has the right of first refusal on investigations involving former residents of the Hissom Memorial Center.OCA may investigate or return the report to APS for investigation.
9.(a) The APS specialist faxes, mails, or emails final investigative findings in summary form to OSDH.Refer to Instruction # 4 for OSDH contact information.
(b) To notify the Oklahoma State Board of Examiners for Long Term Care Administrators (OSBELTCA), the APS specialist:
(1) downloads a pre-formatted letter from the Documents tab of the APS computer system;
(2) obtains a notarized signature from the APS specialist IV; and
(3) sends it to OSBELTCA, 2401 NW 23rd Street, Suite 62, Oklahoma City, Oklahoma 73107.
340:5-5-5. Documentation of APS cases [INSTRUCTIONS TO STAFF ONLY]
Revised 6-1-10
The Adult Protective Services (APS) specialist documents the referral, all interviews, record reviews, other evidence, and findings of all investigations in the APS case.¢ 1
(1) Upon completion of the investigation, the identified caretaker, legal guardian, and next of kin receives a letter from the Oklahoma Department of Human Services (OKDHS) pursuant to Section 10-105.1(C)(6) of Title 43A of the Oklahoma Statutes.
(2) When the vulnerable adult has a court-appointed guardian, the APS specialist notifies the court of jurisdiction of the findings as mandated by 43A O.S. § 10-105.1(C)(6).
INSTRUCTIONS TO STAFF 340:5-5-5
Revised 7-1-12 6-1-13
1.(a) The APS specialist documents investigations on Form 08AP002E, Adult Protective Services Report of Investigation, or its electronic equivalent within 30 calendar days for self-neglect cases and 60 calendar days for cases involving alleged perpetrators after the receipt of the report in the human services center (HSC) county office.The APS specialist files the original Form 08AP002E or its electronic equivalent in the "W" drive and routes copies to the local district attorney's office.
(b) Form 08AP002E is a summary of the investigation and is not used as a tool to complete the investigation.The full case documentation on the APS Computer System provides a detailed chronological account of the entire investigation process, including:
(1) specific circumstances of the report;
(2) date and time of the home visit;
(3) persons present during the home visit;
(4) condition of the vulnerable adult and the vulnerable adult's environment;
(5) information from collateral contacts, including date and time;
(6) APS specialist's evaluation of vulnerable adult's capacity to consent to services;
(7) assessment of risk;
(8) APS specialist's determination of whether the report is substantiated or unsubstantiated;
(9) results of follow-up visits, including date and time;
(10) assessment of vulnerable adult's needs;
(11) proposed service plan for substantiated investigations;
(12) circumstances of vulnerable adult's acceptance or refusal of services offered;
(13) information concerning the actual delivery of services; and
(14) detailed descriptions of all legal actions and follow-up activities for vulnerable adults receiving involuntary services.
(c) The APS specialist must document each new APS referral in the Intake Section of the APS Computer System.If there is no existing APS case number for the alleged victim, a new case must be is opened.For all APS referrals, the APS specialist must enter into the computer system enters the relevant information, including receipt of referral, case findings of substantiated or unsubstantiated, and services actually provided, including any legal actions initiated into the computer system.
(d) The APS specialist III and IV must successfully complete the APS Specialist III and IV Academy to be able to provide adequate supervisory support for an APS specialist.
(e) APS cases require documentation of a review by an APS specialist IV or staffing in the Notes Section of the APS Computer System at:
(1) intake;
(2) risk, needs, and capacity assessments;
(3) the determination of findings;
(4) legal action determinations;
(5) service planning;
(6) extension requests;
(7) appropriate follow-up; and
(8) closure.
(f) At the conclusion of the investigation, the APS specialist routes Form 08AP002E to the local district attorney.A summarized report is sent to any appropriate licensing agency.In substantiated investigations, the APS specialist works closely with the facility to develop a plan that addresses substantiated elements of the investigation.
(g) The APS specialist submits a summary of the investigation, omitting the reporter's identity, to the Nurse Aide Registry at the Oklahoma State Department of Health for all substantiated referrals against certified nurse aides.For substantiated referrals against licensed nurses, information is submitted to the Oklahoma State Board of Nursing, 405-962-1800, fax 405-962-1826.
(h) The APS specialist sends a summary notification of findings to the caretaker, legal guardian, and next of kin.This statement includes:
(1) whether the Oklahoma Department of Human Services (OKDHS) has determined the findings to be substantiated or unsubstantiated; and
(2) a summary of the OKDHS recommendations of OKDHS concerning the vulnerable adult.
340:5-5-6. Provision of adult protective services (APS) to vulnerable adults receiving APS services
Revised 10-28-11 6-1-13
(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 vulnerable adult 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 (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, the APS specialist follows procedures described in (3) of this subsection.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 vulnerable adult 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 vulnerable adult's funds only upon order of the court.If payment is required for involuntary services, procedures described in (3) of this subsection are followed if:
(A) no funds are available from the vulnerable adult'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 Office of General Counsel 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 subsection (e).¢3
(e) Petitioning the court - order enjoining caretaker.When the vulnerable adult's caretaker refuses to allow the provision of protective services to which the vulnerable adult 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 vulnerable adult's refusal in the case narrative or on Form 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 per OAC 340:5-1-4.
(g) Religious beliefs.A vulnerable adult has the right to depend on spiritual means for healing through prayer, in accordance with the practices of a recognized religious method in accordance with the tenets and practices of said place of worship as mandated by 43A O.S. § 10-103(B).¢ 5
(h) Involuntary protective services.Involuntary protective services are authorized by 43A O.S. § 10-107.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.In accordance with 43A O.S. § 10-107(B)(1), the court authorizes provision of specific services that the court finds least restrictive of the rights and liberty while consistent with the welfare and safety of the person involved.
(i) 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 vulnerable adult's residence or in a county where any of the protective services are provided.¢6
(1) If the court issues an emergency order to provide protective services, 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.¢7
(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.
(j) Do not resuscitate (DNR).In accordance with 43A O.S. § 10-108(A), only the court may make decisions regarding the granting or denying of consent for a DNR order, the withdrawal of hydration or nutrition, or other life-sustaining treatment.
(k) 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 (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 vulnerable adult.¢8
(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 43A O.S. § 10-108(D).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 vulnerable adult and attorney, if known, of a hearing to be held within that 72-hour period.¢9
(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.
(l) Emergency services responsibilities for out-of-home placements.As a result of a substantiated investigation, the APS specialist develops a service plan to address the identified needs and safety issues.¢ 10
(1) All out-of-home placements, including any change of placement, of vulnerable adult's 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.
(A) Protective services that may be authorized by an emergency court order may include a change of residence only if the court gives specific approval for such action and names the facility in its order.
(B) Emergency placements may be made to nursing homes, personal medical institutions, other home placements, or other appropriate facilities that provide services appropriate for the vulnerable adult's age and condition.
(C) Emergency placement shall is not be made or construed as an alternative to emergency detention and protective custody as authorized under 43A O.S. § 5-206, et seq., or made or construed as an alternative to involuntary commitment under 43A O.S. § 5-410, et seq., when the person otherwise meets the criteria for involuntary commitment.
(D) Services provided to vulnerable adults are provided in a setting that is segregated from residents of a facility who have been determined to be a danger to others.¢ 11
(2) When the service plan recommends out-of-home placement for safety, health, and care needs, the APS specialist discusses this the plan with the vulnerable adult.The vulnerable adult 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 vulnerable adult's family, if appropriate and approved by the vulnerable adult, is included in the planning stages.The vulnerable adult 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.
(3) 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 vulnerable adult receiving APS services.Placements are determined by the local APS specialist and APS specialist IV, with approval from the county district director and area APS program field representative (PFR).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 Adult and Family Support Services Division (FSSD) (AFS) APS Unit.¢ 12
(m) Restricted visitation.Supervised or restricted visitation with the vulnerable adult may be put in place only by court order as mandated in 43A O.S. § 10-111 when:
(1) consistent with the welfare and safety of a vulnerable adult; or
(2) the vulnerable adult needs protection as the OKDHS investigation determined that maltreatment occurred.
(n) 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 calendar 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 (o) of this Section.
(o) Continuation of services.Continuation of services is authorized by 43A O.S. § 10-108(L).
(1) If, upon expiration of the original 30-day 30 calendar 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) placement of the vulnerable adult in a nursing home, personal medical institution, home placement, or other appropriate facility.
(i) Emergency placement shall is not be made or construed as an alternative to emergency detention and protective custody as authorized under 43A O.S. § 5-206, et seq., or made or construed as an alternative to involuntary commitment under 43A O.S. § 5-410, et seq., when the person otherwise meets the criteria for involuntary commitment.
(ii) Services provided to vulnerable adults are provided in a setting that is segregated from residents of a facility who have been determined to be a danger to others.¢ 11
(2) Before the court enters a 180 calendar day order for continued protective services, the court directs that an evaluation of the vulnerable adult is conducted and submitted to the court within 30 calendar days at a review hearing.The evaluation shall include 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 subsection (k) if this Section.
(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 vulnerable adult 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 30 O.S. § 3-101, the Oklahoma Guardianship and Conservatorship Act.Interested persons are referred to the office of the district court for further information and assistance.
(7) If the alleged victim's mental state is in question, the APS specialist may request the court to order a psychological or psychiatric evaluation.¢ 13
(p) 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 180 calendar days, as authorized by 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 180 days as needed.
(q) Sale of real property.In the event that temporary guardianship extends for more than one year or the vulnerable adult 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 Office of General Counsel.The fact that the vulnerable adult would be in jeopardy for receipt of SoonerCare (Medicaid) if the property was not sold shall be is stated in the court order directing the sale of the real property.
(r) 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.¢ 14
(s) 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 vulnerable adult residence, resources, and belongings.This includes:
(1) securing the residence, checking and gathering the mail, and feeding or arranging for care for the vulnerable adult's domestic animals or livestock;
(2) inventorying the vulnerable adult's home and personal property, using a 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.¢ 15
(B) All persons present during the inventory must sign a document attesting to the authenticity of the inventory and/or the photographic record noting the date and their professional affiliation;
(3) establishing an account at a local financial institution and depositing any cash and uncashed checks; and ¢ 16
(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 an OKDHS representative of OKDHS, for as long as the temporary guardianship is in effect.
(t) 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 vulnerable adult;
(2) submits an accounting to the court as ordered by the court, no less than annually;
(3) works with the court, the vulnerable adult's attorney, the DA, and the OKDHS Office of General Counsel 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 vulnerable adult's circumstances that include, but are not limited to, the timely:
(A) payment and documentation of the vulnerable adult's expenses, and other bills as they occur.¢17
(B) deposit of funds received;
(C) redirection of incoming funds to the new account; and
(D) protection of existing accounts.
(u) Responsibility of APS specialist - involuntary protective services.In cases where temporary guardianship of the person has been was 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 vulnerable adult;
(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) any other type of facility licensed to provide 24-hour care and/or services for vulnerable adults;¢ 18
(5) making application or completing reviews for any state or federal programs on behalf of the vulnerable adult for which he or she is or may be eligible to receive; or¢ 19
(6) making arrangements for facilities to be paid from the vulnerable adult's funds or resources.
(v) Responsibility of APS specialist - emergency out-of-home placement - ex-parte hearing.When an emergency situation requires immediate placement, the APS specialist places the vulnerable adult 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.¢ 20
(w) Enforcement of involuntary court orders.To enforce an involuntary order of protective services, 43A O.S. § 10-108 provides that the court may order:
(1) forcible entry of the premises of the vulnerable adult to be protected;
(2) transportation by law enforcement of the vulnerable adult to another location; or¢ 21
(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.
(x) Dismissal of involuntary court orders.When the vulnerable adult is subject to an involuntary court order and OKDHS serves in the role of temporary guardian, after the temporary order has expired, the APS specialist is responsible for responding to a court's request to dismiss the guardianship by preparing a motion for the OKDHS attorney's consideration for an order of dismissal when it is no longer needed.¢ 22
INSTRUCTIONS TO STAFF 340:5-5-6
Revised 10-28-11 6-1-13
1.The Adult Protective Services (APS) specialist assists a vulnerable adult, when needed, in making application for public or private assistance programs by:
(1) completing application forms; and
(2) gathering documentation necessary to determine eligibility.
2.(a) When the APS specialist determines the vulnerable adult needs emergency services and 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 the:
(1) vulnerable adult has an open referral and an emergency as defined by policy per OAC 340:5-1-6;
(2) APS specialist has verified the vulnerable adult has no funds to pay for the services and family members and local or area district resources are unwilling or unable to assist;
(3) vulnerable adult and APS specialist have explored and applied for all state and federal programs for which the vulnerable adult may be eligible;
(4) 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;
(5) Emergency Fund Section of the APS Computer System is completed and submitted; and
(6) APS specialist IV and APS program field representative's (PFR)'s district director'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) county office 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 Adult and Family Support Services Division (FSSD) (AFS) Adult Protective Services (APS) Unit 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 AFS 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 county office staff when claims have been paid in the Emergency Fund Section of the APS Computer System.
3.The date, time, and circumstances of the vulnerable adult's consent are documented in the 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 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.Nothing shall be is construed to interfere with a vulnerable adults right to practice his or her religion through reliance on prayer alone for healing when this choice:
(1) was expressed, either orally or in writing, by the vulnerable adult who retained capacity at the time of the decision;
(2) previously was set forth in a living will, health care proxy, or other advance directive document that is validly executed and applied under State state law; or
(3) may be clearly determined it is a part of the life history of the vulnerable adult.
6.(a) The APS specialist must have a face-to-face interview with the vulnerable adult within 24 hours prior to the filing of a petition for involuntary services.
(b) The petition must have "approved as to form" be approved and signed by the district attorney, assistant district attorney, or the OKDHS Office of General Counsel 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 vulnerable adult.When two or more counties are involved with a vulnerable adult receiving involuntary services, close communication and coordination is required to ensure the vulnerable adult's needs are met.
(d) If a vulnerable adult'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 vulnerable adult, 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.
7.The services to be provided must be specifically listed in the court order, including the names of any facilities or agencies that will be service providers for the vulnerable adult.
8.The APS specialist serves notice on the person who is the subject of the petition unless the situation is potentially dangerous.When there is the possibility of danger to the APS specialist, the APS specialist may request assistance from a law enforcement officer.If the client has retained or been appointed an attorney, notice is also served on the attorney.
9.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 PFR district director before presenting the petition and evidence to the court for a decision.
10.See Refer to OAC 340:5-5-3, Instructions to Staff # 5 and # 6 for additional information.
11.The APS specialist confirms with the facility prior to placement that the vulnerable adult will be segregated from any residents who have been determined to be a danger to others.
12.These include, but are not limited to, reviewing Oklahoma State Department of Health (OSDH) survey reports at http://www.ok.gov/health/, Long Term Care Investigations (LTCI) records through FSSD AFS ApplicationXtender Web Access, and information available from the Long Term Care Ombudsman at the local Area Agency on Aging office.The AFS APS Unit 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 AFS.Vulnerable adults 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 vulnerable adults receiving APS services and their guardian, caretaker, or next of kin are also thoroughly documented in the case record.
13.If it appears the vulnerable adult has possibly regained capacity, OKDHS Office of General Counsel, the district attorney, or other attorney may make a motion to the court requesting an order for a psychological or psychiatric evaluation to determine the vulnerable adult's mental state.This evaluation may be completed by an outpatient appointment.
14.Personal property may consist of automobiles, furniture, televisions, or other household goods that the client is not expected to need for the duration of the court order.
15.Exceptions to this must be approved by the county district director and documented in the Notes Section of the APS Computer System.
16.(a) The account must be established using the name of the APS specialist and one other OKDHS employee, preferably the county director APS specialist IV or designee.
(b) The APS specialist documents account information in the Estate Management Section of the APS Computer System.The APS specialist scans copies of the check registry and other pertinent documentation in the case file on the "W" drive.Financial institutions that require Social Security numbers are given the OKDHS federal employee identification (FEI) number.In no instance does the APS specialist provide their personal Social Security number for a vulnerable adult's financial account.
17.Cash transactions are strongly discouraged and the use of automatic bank drafts by the vendors are preferred.The APS specialist must reconcile monthly bank statements and document all cash transactions with receipts that are scanned into the "W" drive and maintained in the local HSC county office.All cash transactions must be witnessed by a third party.
18.Involvement of the vulnerable adult 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) vulnerable adult's preferences and desires;
(B) family preferences and desires;
(C) vulnerable adult's medical condition, needs, and recommendation of physician;
(D) unique circumstances of the vulnerable adult's situation in order to provide appropriate and safe level of care;
(E) availability of facilities to meet vulnerable adults needs;
(F) acceptance of the vulnerable adult by facility; and
(G) payment arrangements, availability, and affordability.
(2) The APS specialist documents this assessment criteria in the case record and makes it available at the request of the court in the form of a written report.
19.(a) Applying for or maintaining benefits and services for the vulnerable adult includes:
(1) monitoring the receipt of benefits;
(2) acquiring and assisting with obtaining documents needed to determine eligibility for benefits;
(3) documenting in the Guardianship Section of the APS computer system:
(A) the case number(s) for any benefits the vulnerable adult is applying for or receiving;
(B) how to contact the person at each agency who is responsible for certifying or reviewing the vulnerable adult's eligibility for each benefit or service; and
(C) when reviews are due for the benefits or services the vulnerable adult is receiving.
(b) When the guardianship expires or is dismissed, arrangements must be in place and documented in the Service Plan Section of the APS computer system for the ongoing maintenance of benefits for the vulnerable adult.
(c) When a vulnerable adult possessing a Medicaid Income Pension Trust (MIPT) dies, the APS specialist immediately notifies the vulnerable adult's eligibility worker of the death.The eligibility worker notifies staff in the AFS Heath & Medical Services Section and requests termination of the MIPT per OAC 317:35-41.6(6)(B)(xi).
20.Refer to OAC 340:5-5-6(l)(2) of this Section for emergency out-of home placement to a nursing home.
21.Refer to OAC 340:5-5-6(b) of this Section for information regarding payment of transportation expenses.
22.(a) Prior to filing for dismissal of an involuntary court order, the APS specialist:
(1) consults with the APS Specialist IV to determine if dismissal is warranted; and
(2) discusses and staffs the pleadings with the attorney representing OKDHS in the matter as to form.
(b) After receiving approval from the APS specialist IV and attorney, the APS specialist files the petition with the court clerk and obtains a dismissal order from the court.
(c) After obtaining the dismissal order, the APS specialist:
(1) scans the petition and the order into the "W" drive;
(2) updates the Service Plan Items Section of the APS Computer System;
(3) closes involuntary services; and
(4) updates service plan monitoring notes showing the date of the dismissal and action by the court.
