Transcript Learning Objectives *Understand the role of APS in facilities

Adult Protective Services in Facilities
Division of Aging and Adult Services
Learning Objectives
• Understand the role of APS in facilities.
• Understand how APS collaborates with others
to protect disabled adults.
• Understand the difference between protection
of individuals and regulation of facilities.
• Be knowledgeable of the variety of records
pertaining to the adult’s care.
• Gain skills and knowledge in use of resources
in a facility evaluation.
• Be knowledgeable of the diverse methods of
protecting adults in facilities.
Role of APS
Focus on the Victim – Not the Facility
This is the primary mission of APS in facilities
Protection Vs. Regulation
APS protects the victim. Other agencies regulate
and/or enforce
Facility Vs. domestic Setting
Cannot hold facilities to a higher standard than
other settings
Keep Perspective on the Total APS Workload
APS Reports on Adults in Facilities comprise 20%
of all reports
Separating Regulatory
from Protective Issues at Intake
Reports may be:
• Specific to APS,
• Involve APS and regulatory issues,
• Or may be specific to regulatory issues.
APS vs. Regulatory
•What are examples of APS only situations
•What are examples of Both APS & Regulatory
Issues
Licensure Issues vs. Protective Services
• If the complaint relates only to general conditions,
the report is referred to the appropriate licensing
authority
Adult Care Homes
• Adult care homes are residences for aged and disabled adults who
may require 24-hour supervision and assistance with personal care
needs.
• Vary in size from family care homes of two to six residents to adult
care homes of more than 100 residents. The smaller homes, with 2
to 6 residents, are still referred to as family care homes.
• Adult care homes are different from nursing homes in the level of
care and qualifications of staff. They are licensed by the state
Division of Health Service Regulation (Group Care Section) under
State regulations and are monitored by Adult Home Specialists
within DSS.
Nursing Homes
• Nursing Homes are facilities that provide nursing or convalescent
care for three or more persons. A nursing home provides long term
care of chronic conditions or short term convalescent or
rehabilitative care of remedial ailments, for which medical and
nursing care are indicated.
• All nursing homes must be licensed in accordance with North
Carolina State law by the North Carolina Division of Health Service
Regulation Licensure Section (919) 733-1610.
Who is a Caretaker?
• The level of responsibility that a facility has
for an individual resident will vary
• There may be activities or time frames when
the facility is NOT acting as a caretaker
APS Manual III-48
The Complainant and Confidentiality
The complainant’s name will not be released
except to:
•
DHSR
•
The DA
•
Law Enforcement, or
•
By Court Order
APS Manual III-47
Returning to a Facility from a Hospital
•When a referral comes from the hospital, the
referral should be considered an APS report if the
APS criteria are alleged
•Refer to AHS for licensure issues.
The Initial Visit
APS Manual III-51
 Be professional and in control
 Notify the person in charge when you arrive at the
facility
 Go directly to see the disabled adult.
 State that you will need all the records
 pertaining to the adult
 Give the staff a description of what will be needed for
the evaluation
 Always carry a copy of 108A – 103 a & b
The Assessment
APS Manual III-51
The same process as in domestic settings
• Visit with the adult
• Collateral Contacts
• Obtain medical records as needed
• Interview the adult alone
• Interview the adult before discussing the allegations with
administrator or contacting collaterals
The Assessment cont…..
• Don’t be intimidated by Medical or Other Professional Terms
Be Inquisitive (ask questions)
Familiarize yourself with medical terminology & common
medications
• Find and use local resources
• Focus on facts
Working with the Facility Staff
Establish a relationship with a staff person
Make multiple visits and interview multiple sources
• Roles and Conflicts
• Maintaining rapport
• Stall tactics used by facilities
Working with Family Members
• Include family members as collaterals
• Contact family members early in the evaluation.
Interviewing
• Know who to interview
• Use good interviewing techniques
• Know when is it appropriate to interview
Facility Records
• Review ALL records that pertain to the
disabled adult
• Look for specific changes indicated in these
records
APS and the AHS
How the roles overlap
• Patient/Resident rights
• Regulation versus protection
Best Practice
• APS and AHS visit a facility together
• APS and AHS coordinate efforts
Other Regulation or Enforcement Entities
DHSR
Complaint Investigation
Mental Health Section
The AHS
Health Care Personnel/Nurse Aide Registry (internal
process within DHSR)
Area Mental Health Authority/LME
The DA and Law Enforcement
Other Disciplines and Agencies
• GACPD
• Case Managers
ACH/MH
• Hospitals and Physicians
• Ombudsman
• Day Programs
• Home Health
• PT and OT
• Facility Psychologist or Social Worker
• EMS/Rescue
• Dietician
NCDHSR Complaint Section
http://www.ncdhhs.gov/dhsr/ciu/complaintintake.html
• Division Contact: Rita Horton
• Complaint Hotline: 1-800-624-3004 (within N.C.) or 919855-4500
• Complaint Hotline Hours: 8:30 a.m. - 4:00 p.m. weekdays,
except holidays.
• Fax: 919-715-7724
• Mail: 2711 Mail Service Center, Raleigh, NC 27699-2711
• Adult Care Homes-Adult Homes Specialist
• APS Manual III-48
Common Issues Handled by Other Agencies and
Contact Information
• Physicians and Urgent Care Centers - N.C. Medical Board
(1-800-253-9653)
• Labor/Personnel Issues - N.C. Department of Labor
(1-800-625-2267)
• Health Insurance Portability and Accountability Act (HIPAA)
Complaints - U.S. Office of Civil Rights (1-800-368-1019)
• Discrimination Complaints - U.S. Office of Civil Rights
(1-800-368-1019)
• Medicaid Fraud - N.C. Division of Medical Assistance
(919-647-8000)
• Medicare Fraud - U.S. Office of Inspector General
(1-800-447-8477)
Health Care Personnel Registry
https://www.ncnar.org/index1.jsp
• The Division of Health Service Regulation also maintains the
North Carolina Nurse Aide I and Health Care Personnel
Registry.
• This site is designed to assist individuals and facilities who
wish to access the Nurse Aide I and Health Care Personnel
Registry databases for pre-employment verification of an
applicant's credentials
Keep and Use Current Resources
• Medical Abbreviations List
• Medications Guide
• Chart of Decubitus Ulcers
• Possible Indicators of Mistreatment
• Consult with Experts
Medical Information Websites
• Medline Plus
www.nlm.nih.gov/medlineplus/
• Rx List www.rxlist.com
• Health Square
www.healthsquare.com
Case Decision
• The same process as domestic settings
• Look for facts. Be specific.
Notices and Written Reports
The focus is on factual information
The written report should be tailored to meet the needs of the
agency or the person receiving it:
• DHSR
• DMA
• DA
• Other agencies
The written summary to the administrator shall be limited to:
• Acknowledgement that a protective services report was
received on a specified patient or resident of the facility
• The allegations in the report (the reporter shall NOT be
named)
• Whether or not mistreatment was found
• Whether the need for protective services
was substantiated
A general statement as to how the conclusion was
reached (collaterals shall not be named)
APS Manual III-47
Notice to Administrator cont….
Can be used for the written summary to the
administrator
A copy shall be sent to DHSR within 30 days of
completion of the evaluation
APS Manual III-47
Planning Services
This is your opportunity to fix the problem
Plan with:
• the disabled adult
• the Family,
• the Facility, and the other agencies
• Corrective action is NOT an APS plan
Thank You!