Audit of the Executive Office of Elder Affairs Overview of Audited Entity

This section describes the makeup and responsibilities of the Executive Office of Elder Affairs.

Overview

According to the Executive Office of Elder Affairs’ (EOEA’s) 2020 Annual Legislative Report, its core mission is to “develop, implement, and evaluate innovative programs to promote the independence, empowerment, and well-being of older adults, individuals with disabilities, and their caregivers.” EOEA, established by Section 1 of Chapter 19A of the Massachusetts General Laws, contracts with a network of Aging Services Access Points,² 19 of which are designated protective service agencies (PSAs), in various regions throughout the Commonwealth that receive and investigate reports of alleged elder abuse on behalf of EOEA in accordance with procedures established by EOEA. These 19 PSAs, if necessary, make referrals so that elders can seek other services, including, but not limited to, housing, nutrition, in-home support, caregiver support, and healthcare counseling.

EOEA’s fiscal year 2020 budget was $555,438,273, of which $32,721,172 was allocated to its Protective Services Program. In fiscal year 2021, the budget was $591,064,464, of which $36,348,223 was allocated to the Protective Services Program.

Protective Services Program

EOEA administers its Protective Services Program from its central office in Boston and from the 19 designated PSAs across the Commonwealth. Through this program, EOEA enters into contracts with PSAs to process reports of alleged abuse of elders. According to Section 16(c) of Chapter 19A of the General Laws,

Subject to appropriation, [EOEA] shall designate at least one local agency to act on behalf of the department with a geographic area as defined by the department. The department may designate any public agency or private nonprofit organization which has the capacity to implement a service plan through direct access to social, health and mental health services.

While the aforementioned law allows EOEA to designate some protective service responsibilities to PSAs, Section 16(c) of Chapter 19A of the General Laws also requires EOEA to “monitor assessments, evaluations and the provision of protective services by designated local agencies.” To accomplish this, EOEA has annual performance metrics³ that the PSAs must meet, and the Protective Services Program has assigned a program director and three regional program managers to oversee this process.

Abuse Report Receipt

PSAs receive abuse reports in a variety of ways, such as by telephone, email, online intake reports, walk-ins, fax, or mail. Section 15 of Chapter 19A of the General Laws requires certain professionals whose work directly involves elders to make an immediate verbal report and a subsequent written report to a designated PSA within 48 hours when they have reasonable cause to believe that an elder is suffering from, or has died as a result of, abuse.

Abuse Report Screening

Upon receipt of a verbal or written report (whichever the PSA receives first) of alleged abuse of an elder, the PSA is required to ensure that the report is evaluated immediately by a PSA supervisor or a designated backup supervisor. According to Section 5.09 of Title 651 of the Code of Massachusetts Regulations (CMR), a PSA supervisor is required to screen reports as follows:

To determine the immediacy and severity of the alleged harm or risk, and the appropriate initial response. . . .

(a)  To determine whether the allegation constitutes a Reportable Condition to the Protective Services Program/Agency, and

(b)  To determine whether or not an Emergency, Rapid Response, or Routine response is needed.

According to 651 CMR 5.02, a reportable condition is one of the following:

(a)  Abuse;

(b)  Physical Abuse;

(c)  Sexual Abuse;

(d)  Emotional Abuse;

(e)  Neglect;

(f)   Self-neglect; and

(g)  Financial Exploitation.

If the PSA supervisor determines that a report needs an emergency response,⁴ they must immediately assign it to a PSA caseworker for investigation. The PSA caseworker must assess the needs of the allegedly abused elder within 24 hours after it receives the abuse report. If the PSA supervisor determines that a report needs a rapid response,⁵ the supervisor must immediately assign the report to a PSA caseworker for investigation, and a PSA caseworker must assess the needs of the allegedly abused elder within 72 hours after it receives the report. If the PSA supervisor determines that a report needs a routine response, a PSA must assess the needs of the allegedly abused elder within five days after it receives the report. If a PSA caseworker determines that there is no reasonable cause to believe⁶ that the allegation of abuse constitutes a reportable condition, the PSA supervisor determines that an investigation of the allegation is not necessary.

Investigation of Alleged Abuse

PSAs are required to investigate information from reports of alleged abuse of elders. Investigations include in-person visits to the residences of elders who are the alleged victims of abuse and may include meeting with appropriate service agencies, such as medical offices or social work agencies, and, according to Section 18(a) of Chapter 19A of the General Laws, “individuals who have knowledge of the elderly person’s situation including the person filing the report.” If a PSA’s investigation determines that the allegations are substantiated, it must immediately refer the report to protective services, which offers a variety of services, including, but not limited to, medical care, mental health care, home care, and legal services.

At the conclusion of an investigation, if a PSA caseworker determines that there is no reasonable cause to believe that a reportable condition exists, they conclude, with approval from the PSA supervisor, that the allegations are unsubstantiated.

Referrals to District Attorneys’ Offices

EOEA’s designated PSAs must refer all substantiated reports of serious abuse to the district attorney’s (DA’s) office that covers the county where abuse occurred. At the conclusion of an investigation, if a reportable condition other than death is substantiated and meets the conditions of 651 CMR 5.19(2), the PSA must submit a referral to a DA’s office within 48 hours. Under 651 CMR 5.19(2), reportable conditions other than death that required a DA referral included, but were not limited to, “brain damage,” “fracture of a bone,” “sexual assault,” “serious bodily injury as the result of a pattern of repetitive actions,” “financial exploitation” involving potential “criminal” behavior, and any other injury that was deemed “non-trivial.” If it is determined that the elder died because of the abuse, the PSA is required to make an immediate referral to a DA’s office, and a written follow-up notice must be made available to the DA’s office as soon as possible. EOEA conducts a review, called a designation review, of PSAs every three years to ensure compliance with 651 CMR 5.

Interview for Decisional Abilities Tool

In 2016, EOEA applied, and was approved, for a grant from the Administration for Community Living⁷ for the implementation of a standardized screening form called the Interview for Decisional Abilities (IDA) tool and the development of a standardized Protective Services Program training curriculum for PSAs on the IDA tool. EOEA implemented the IDA tool in October 2017 for PSA caseworkers to assess whether an elder appears to require a professional evaluation of their decisional capacity. According to 651 CMR 5.02, decisional capacity is,

An Elder’s ability to:

(a)  understand and appreciate the nature and consequences of decisions, including the benefits and risks of and alternatives to any proposed Protective Services; and

(b)  reach an informed decision while free from any apparent duress, intimidation, coercion, use of force, or threat of force by another.

A PSA caseworker’s screening of decisional capacity includes an assessment of the elder’s living situation and how they function in their environment (for example, who they live with, their hygiene, their ability to feed and bathe themselves, their ability to get out of bed independently, etc.). All potential conditions of abuse (such as verbal abuse or abandonment by family members, confusion, or injuries) that are observed are recorded. The purpose of the screening is to determine whether a comprehensive evaluation is required. A comprehensive evaluation is only conducted by an appropriately licensed healthcare professional and may include a physical, a neurological examination, a memory assessment, an executive function assessment, and/or a mental health assessment.

EOEA’s Adult Protective Services System

The Adult Protective Services (APS) system is an online system that EOEA uses to document reports of alleged abuse of elders. EOEA also uses it to maintain case notes, referrals, and inquiries, as well as to run a variety of general and administrative reports on incidents, abuse reports, and investigations of alleged abuse of elders. PSA caseworkers use the APS system for pending notifications for action, cases, investigations, and other tasks. Additionally, PSA supervisors document their screening decisions in the APS system before initiating investigations. Abuse reports received by PSAs are transcribed into the APS system by PSA caseworkers.

Office of the Comptroller of the Commonwealth’s Pandemic Response Guidance

On September 30, 2020, the Office of the Comptroller of the Commonwealth provided guidance in response to the 2019 coronavirus (COVID-19) pandemic for state agencies. The guidance helped state agencies that were experiencing significant changes identify their goals, objectives, and risks associated with the COVID-19 pandemic. Objectives included telework; return-to-office plans; a risk assessment of the impact of COVID-19 on department operations; changes to the business process; safety protocols for staff members and visitors; and tracking of COVID-19–related awards and expenditures, which were tracked separately from other federal, state, and local expenditures.

Cybersecurity Awareness Training

The Executive Office of Technology Services and Security has established policies and procedures that apply to all Commonwealth agencies. Its Information Security Risk Management Standard IS.010 ensures that all Commonwealth personnel are trained annually for cybersecurity awareness. Section 6.2 of the document states that the objective of information security training is to “educate users on their responsibility to help protect the confidentiality, availability and integrity of the Commonwealth’s information assets.”

2.    According to Section 5.02 of Title 651 of the Code of Massachusetts Regulations, Aging Services Access Points are “locally based private, non-profit corporations which contract with [EOEA] to provide community based services to certain Eligible Elders."

3.    EOEA requires its contracted PSAs to ensure that services produce desired results and meet the requirements of the contract. The contracts specify the Protective Services Program outcomes and measures, which are the performance metrics. There are annual revisions to performance targets, or new target goals established, during the yearly contract modification process. The contracted PSAs are required to meet with EOEA, as necessary, to review performance under the contract.

 

4.    According to 651 CMR 5.02, an emergency is “an abusive situation in which an Elder is at risk of: (a) imminent death; (b) immediate and Serious Physical Injury or emotional harm; and/or (c) immediate, substantial and irrevocable financial loss.”

5.    According to 651 CMR 5.02 a rapid response is “a non-emergency, but urgent situation in which an Elder is living in conditions which present a potential, or rapidly developing risk of Serious Physical Injury or emotional harm; or a potential, or developing risk of immediate, substantial and irrevocable financial loss.”

6.    According to 651 CMR 5.02, “reasonable cause to believe” is “a basis for judgment that rests on specific facts, either directly observed or obtained from reliable sources, that supports a belief that it is more probable than not that a particular event took place or a particular condition exists.”

7.    The Administration for Community Living gives grants to organizations and states that provide services to the older population and people with disabilities.

Date published:	April 25, 2023