EOEA Did Not Monitor the Use of the Interview for Decisional Abilities Tool To Ensure That Its PSAs Properly Assessed Whether a Healthcare Professional Should Evaluate the Decisional Capacity of Elders.

By not monitoring use of the IDA tool, EOEA cannot ensure that elders are making coherent decisions when refusing protective services, which puts them at risk of continued abuse.

Overview

We found that during our audit period, EOEA did not monitor the use of the Interview for Decisional Abilities (IDA) tool to ensure that its PSAs properly assessed whether a healthcare professional should evaluate the decisional capacity of elders. PSA caseworkers are required to upload each IDA tool form as a static Portable Document Format file⁸ to the APS system. However, we determined that EOEA has not yet established the ability to extract information from the IDA tool forms in the APS system, which would allow it to effectively monitor each PSA’s compliance, nor are EOEA staff members manually reviewing data from the IDA tool forms in the APS system to monitor compliance with this requirement.

By not monitoring use of the IDA tool, EOEA cannot ensure that elders are making coherent decisions when refusing protective services, which puts them at risk of continued abuse.

Authoritative Guidance

Section 16(c) of Chapter 19A of the Massachusetts General Laws states, “The department shall monitor assessments, evaluations and the provision of protective services by designated local agencies.”

Reasons for Issue

EOEA is currently working on an enhancement of the APS system’s reporting capabilities because the system currently is unable to pull the data to monitor the use of the IDA tool. However, this should not have prevented EOEA from conducting manual reviews of the data from the IDA tool forms in the APS system or requiring that PSAs report their usage of the IDA tool in their annual performance metric reviews to EOEA.

Recommendation

EOEA should establish a manual review process of the data from the IDA tool forms while it works on enhancements to its system to ensure that its PSAs are properly assessing the decisional capacity of elders.

Auditee’s Response

EOEA has already implemented a training program to ensure that the IDA tool is properly used by PSA staff throughout all operating areas. In addition to confirming that PSA caseworkers complete the required training, an automated system will be developed to identify a sample pool of IDA forms for manual review on a monthly basis to ensure that the forms are correctly processed.

Auditor’s Reply

Based on its response, EOEA must continue to take measures to address our concerns related to monitoring the effectiveness of the IDA tool, which was implemented in October 2017.

8.    Static Portable Document Format files contain text that is not automatically readable/searchable within the APS system.

Date published:	April 25, 2023