Greater Springfield Senior Services, Inc. Did Not Always Report Incidents of Abuse to District Attorneys’ Offices for Investigation.

Not reporting incidents of alleged abuse for investigation puts seniors at risk.

Overview

We reviewed 60 instances of substantiated⁶ allegations of abuse of elderly persons investigated by Greater Springfield Senior Services, Inc. (GSSSI) during the audit period and found 2 instances of alleged abuse that resulted in determinations of reportable conditions but did not have adequate, verifiable documentation in their case files in the Adult Protective Services (APS) system that reports were made to a district attorney’s (DA’s) office as required. Without making referrals to DAs’ offices and adequately documenting them in APS, GSSSI cannot be certain that it has taken the necessary steps to ensure appropriate investigation, prosecution of alleged perpetrators of abuse, and mitigation of risks of abuse.

In both instances, case records indicated that a Protective Services Unit supervisor determined that a referral must be made to the DA’s office. However, GSSSI was not able to verify or provide evidence that the referrals were ever made. One of these instances involved an elderly person who was a victim of extensive financial exploitation, which included theft and unauthorized credit card and bank account use, leaving the person with overdrawn bank accounts and a risk of eviction. The other instance was a case of substantiated allegations of physical abuse against an elderly person by the person’s spouse. Although the case records did not contain evidence that these instances were reported to the DA’s office as required, we found that the Protective Services Unit supervisor did approve the investigations and close out the cases.

Authoritative Guidance

Section 5 of Title 651 of the Code of Massachusetts Regulations (CMR) was updated during our audit period, as of January 13, 2017. The updates included slight changes to the language addressing the reporting of reportable conditions to DAs’ offices. According to the version of 651 CMR 5.19(2) that was in place before the update,

If an Investigation results in a determination that the Elder has suffered a Reportable Condition(s) to the District Attorney as defined in 651 CMR 5.02, the Department or Protective Services Agency shall report such determination to the District Attorney of the County where the Abuse occurred. . . . A written report on a form provided by the Department shall be forwarded to the District Attorney as soon as possible. The District Attorney may investigate and decide whether to initiate criminal proceedings.

The version of 651 CMR 5.19(2) effective after January 13, 2017 addresses the reporting of reportable conditions to DAs’ offices as follows:

If a Reportable Condition is substantiated and an Investigation results in a determination that the Elder has suffered a Reportable Condition(s) other than death, the Department or Protective Services Agency shall report such determination within 48 hours to the District Attorney of the County where the Abuse occurred for further investigation.

The pre-update version of 651 CMR 5.02(2) was in place during the instance of financial exploitation discussed above. It defined financial exploitation as a condition reportable to a DA’s office:

Conditions reportable to the District Attorney by the Protective Services Agency . . . shall include, but not be limited to, the following . . .

(m) Financial exploitation which involves possible criminal conduct, including but not limited to, the crimes of larceny by stealing, larceny by false pretenses, larceny from the person, larceny by embezzlement, larceny by check, forgery, uttering and extortion, and which possible criminal conduct substantially and seriously affects the financial situation of the Elder.

The version of 651 CMR 5.19(2) effective after January 13, 2017 applies to the instance of physical abuse:

Conditions Reportable to the District Attorney by a Protective Services Agency . . . shall include, but not be limited to, the following . . .

(h)  Soft tissue swelling, skin bruising or tears, depending on such factors as the Elder’s physical condition, circumstances under which the injury occurred, and the number and location of bruises.

Reasons for Noncompliance

GSSSI had not established adequate monitoring controls to ensure that its staff reported all substantiated allegations of reportable conditions to DAs’ offices and maintained adequate documentation in APS for all DA referrals.

Recommendation

GSSSI should establish monitoring controls to ensure that when investigations conclude and conditions reportable to a DA’s office are identified, required documentation is prepared by caseworkers, reported to the DA’s office within 48 hours, and documented in APS.

Auditee’s Response

Since completion of the audit period, it should be noted that the Commonwealth’s Executive Office of Elder Affairs (EOEA) Protective Services department has improved the District Attorney (DA) reporting process through the creation of a pre-generated reporting document, as well as creating job aids and training through the EOEA Protective Services Bulletin.

In order to ensure all reports to the District Attorney’s Office are filed in accordance with 651 CMR 5.19(2), GSSSI will establish a monitoring mechanism to ensure future issues do not occur.

GSSSI will update its policy on reporting to the DA and update training on DA reporting policy to ensure compliance with 651 CMR 5.19(2) and EOEA guidelines.

On June 3, 2019, GSSSI created the position of Protective Services Operations Coordinator (PSOC). One of the main functions of this position is to ensure quality assurance and improvement activities are developed and maintained on a consistent basis. The PSOC will extract data from individual Protective Services Workers (PSWs), as well as supervisory teams to determine the existence of trends. An action plan will be developed in consultation with supervisor(s), other GSSSI departments, and the Executive Director if necessary. The plan will include an assessment of the reasons for non-compliance and/or trends occurring. A plan will be developed and implemented in order to remediate any issues and assessed thereafter for effectiveness.

Furthermore, the [Protective Service Supervisors, or] PSSs will provide the PSOC a list of cases referred to the DA’s office on a monthly basis. The PSOC will follow up with the District Attorney’s office to determine status before the case is closed.

The [Protective Services Program Director] will conduct a mandatory re-training on the use of the DA reporting form on July 25, 2019.

Auditor’s Reply

Based on its response, GSSSI is taking measures to address our concerns in this area.

6.    An allegation of abuse of an elderly person is substantiated when it is determined, as the result of an investigation, that there is reasonable cause to believe abuse exists. If there is no reasonable cause to believe that abuse exists, the allegation is determined to be unsubstantiated.

Date published:	September 4, 2019