GSSSI Did Not Always Properly Perform Investigations of Abuse of Elderly Persons

Serious incidents of elder abuse could continue without conducting proper investigations.

Overview

We reviewed 60 instances of substantiated allegations of abuse of elderly persons, and 40 cases of unsubstantiated ones, investigated by GSSSI during the audit period and identified the following issues with the way GSSSI performed investigations of abuse of elderly persons.

• Four (6.7%) of 60 investigations of substantiated allegations, and 2 (5%) of 40 investigations of unsubstantiated ones, were not initiated within the assigned response time. Initiation of the investigation can include meeting with a supervisor, calling collaterals, or preparing to meet with the elderly person. In all 6 instances, the reports were screened in as “other non-emergency.”
• In 2 (3.8%) of 53 applicable investigations of substantiated allegations, and 5 (16.1%) of 31 applicable investigations of unsubstantiated ones, the Protective Services Unit caseworker did not initiate an in-home visit or other response with the elderly person within the correct timeframe based on the assigned response time.¹¹
• Twelve (20%) of 60 case records for investigations of substantiated allegations, and 2 (5.4%) of 37 applicable¹² case records for investigations of unsubstantiated ones, lacked evidence that the elderly person was notified in writing of the investigation and his/her right to review the protective service file.
• Six (20%) of 30 applicable case records for investigations of substantiated allegations, and 2 (13.3%) of 15 applicable case records for investigations of unsubstantiated ones, lacked evidence that the caseworker conducted interviews with other members of the elderly person’s household.¹³
• Twenty-eight (46.7%) of 60 investigations of substantiated allegations, and 35 (87.5%) of 40 investigations of unsubstantiated ones, were not completed within 30 calendar days.

Without properly conducting investigations of abuse of elderly persons, workers and supervisors could reach incorrect conclusions, allowing the abuse to continue. Additionally, without timely investigations, there is a risk that the alleged abuse, which may be serious and threatening, will continue.

Authoritative Guidance

During our audit period, 651 CMR 5 was updated (as of January 13, 2017). The updates included slight changes to the requirements for investigations of abuse of elderly persons. According to the version of 651 CMR 5.10(2) that was in place before the update,

Process . . .

(b)  For all reports screened as an Emergency the Protective Services Agency shall:

1.   immediately initiate the investigation;

2.   assess the Emergency needs of the allegedly Abused Elder within 24 hours of the receipt of the report. This shall include determination of the need for an in home visit and/or other response, and initiation of this response, within five hours of the receipt of the report . . .

4.   complete the Investigation within 30 calendar days.

(c)  For all reports screened as Rapid Response, the Protective Services Agency shall:

1.   immediately initiate the Investigation;

2.   assess the Rapid Response needs of the allegedly Abused Elder within 72 hours of the receipt of the report. This shall include determination of the need for an in home visit and/or other response, and initiation of this response, within 24 hours of the receipt of the report . . .

4.   complete the Investigation within 30 calendar days.

(d)  For other non-emergency reports, the Protective Services Agency shall:

1.   immediately initiate the Investigation;

2.   make the first home visit or in-person interview with the Elder as soon as possible, but within five days of the receipt of the report, in order to assess possible risk to the Elder;

3.   complete the Investigation within 30 calendar days.

(e)  During the home visit or in-person interview for either an Emergency or a non-emergency situation, written notification . . . shall be given to the Elder that an Investigation is being conducted and that she/he has a right to review the Protective Services file . . .

(f)   [Interview] other members of the Elder’s household.

The version of 651 CMR 5.10(2) effective January 13, 2017 states,

(b)  For all reports screened as an Emergency a Protective Services Agency shall:

1.   immediately initiate the Investigation;

2.   assess the Emergency needs of the allegedly Abused Elder within 24 hours of the receipt of the report. This shall include determination of the need for an in home visit and/or other response, and initiation of this response, within five hours of the receipt of the report . . .

5.   complete the Investigation within 30 calendar days.

(c)  For all reports screened as Rapid Response, a Protective Services Agency shall:

1.   immediately initiate the Investigation;

2.   assess the Rapid Response needs of the allegedly Abused Elder within 72 hours of the receipt of the report. This shall include determination of the need for an in home visit and/or other response, and initiation of this response, within 24 hours of the receipt of the report . . .

5.   complete the Investigation within 30 calendar days.

(d)  For other non-emergency reports, a Protective Services Agency shall:

1.   immediately initiate the Investigation;

2.   make the first home visit or in-person interview with the Elder as soon as possible, but within five days of the receipt of the report in order to assess possible risk to the Elder;

3.   complete the Investigation within 30 calendar days.

(e)  During the home visit or in-person interview for either an Emergency or a non-emergency situation, written notification . . . shall be given to the Elder that an Investigation is being conducted and that she/he has a right to review the Protective Services file. . . .

(f)   [Interview] other members of the Elder’s household.

Reasons for Noncompliance

GSSSI had not established monitoring controls to ensure that it properly performed investigations of abuse of elderly persons. Additionally, GSSSI stated that turnover of Protective Services Unit personnel during fiscal year 2017, and increased caseloads due to changes in the intake and screening process in June 2017, led to delays in conducting investigations.

Recommendation

GSSSI should establish monitoring controls to ensure that investigations are properly conducted in a timely manner, even in the event of increased caseloads and employee turnover.

Auditee’s Response

Since the audit period ended, the practice has been to document in the elder interview the Notice of Assessment (NOA) was given and if not, the PSW is required to provide an explanation. A formal policy will be implemented. PSOC will include as part of her quality assurance monitoring tool a check to ensure the NOA was given and if not, reasons why it could not be given. PSOC will inform PSPD of any instances when an NOA was not given and the PSPD will follow up with the respective PSS.

Compliance regarding response times is also monitored within monthly [quality assurance] review. PSWs are also required to bring new reports to their supervisor upon receiving them, in order to review the report so there is no delay in seeing the elder within assigned response times. Compliance regarding completing cases within the required thirty (30) days continues to be a focus of the [Protective Services, or] PS Unit. All regulatory timeframes will be monitored by PSOC and PSPD on a monthly basis.

Collateral contacts in a case are contacted on an as needed basis in each case. To determine whether a contact, even a member of the elder’s household is contacted, the PSW needs to determine if there is a connection between the collateral and the elder’s situation and that speaking with the collateral will not increase the elder’s current risk. PSPD and PSOC will continue to monitor for compliance in this area as well as documentation as to why collateral(s) were not contacted.

All timeframes related to investigations, service plans and visits with elders, as well as appropriateness of investigatory steps will be monitored and addressed through QA review by both the PSOC and PSPD.

Auditor’s Reply

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

11.    This requirement did not apply to the remaining investigations for various reasons, including the elderly person refusing protective services and the caseworker being unable to establish contact with the person although attempts were made.

12.    This requirement did not apply to the remaining investigations because the caseworker was unable to establish contact with the elderly person in those cases.

13.    This requirement did not apply to the remaining investigations for various reasons, including the elderly person living alone, the elderly person refusing protective services, and the caseworker being unable to establish contact with the person although attempts were made.

Date published:	September 4, 2019