Overview of the Greater Springfield Senior Services, Inc.

This section describes the makeup and responsibilities of the Greater Springfield Senior Services, Inc.

Overview

Greater Springfield Senior Services, Inc. (GSSSI) is a nonprofit organization in Springfield that is funded through contracts with the Massachusetts Executive Office of Elder Affairs (EOEA), federal funding, and private donations. According to its 2018–2021 Area Agency on Aging Area Plan,

[GSSSI’s] mission is to help frail older adults and individuals with disabilities live at home safely and independently for as long as possible by providing assistance and access to a comprehensive range of services to them and their caregivers.

GSSSI has been providing services to eligible persons in the greater Springfield area since its establishment in 1972. GSSSI’s Protective Services Unit is 1 of 20 protective services agencies (PSAs) across the Commonwealth that have been designated by EOEA to help receive and investigate reports of abuse of elderly persons. GSSSI also helps elderly persons seek services such as home care, shared living, home-delivered meals, money management, and adult foster care. GSSSI received approximately $14.8 million from EOEA for fiscal year 2017 and approximately $14.6 million for fiscal year 2018.

Protective Services Program

Section 5.02 of Title 651 of the Code of Massachusetts Regulations (CMR) defines protective services as “services which are necessary to prevent, eliminate or remedy the effects of Abuse to an Elder.” In addition to investigating allegations of abuse of elderly persons, these services include responding to emergency and/or rapid response¹ situations; pursuing protective orders if needed; petitioning courts for appointment of guardians or conservators for elderly persons; and arranging for home care, legal services, and counseling when necessary. As part of the agency’s annual funding, GSSSI’s Protective Services Program received state funding from EOEA of approximately $1.6 million for fiscal year 2017 and $1.5 million for fiscal year 2018.

EOEA’s Adult Protective Services System

GSSSI uses EOEA’s Adult Protective Services (APS) system as its system of record to document reports and investigations of alleged abuse of elderly persons. APS is a Web-based database system that is configured and maintained by EOEA. GSSSI’s Protective Services Unit caseworkers use APS to document and maintain all case activity and referrals. GSSSI’s Protective Services Unit supervisors use APS to manage case progress and deadlines and to document screening decisions and investigation dispositions, which are determinations of whether abuse has been substantiated as a result of investigations.

Protective Service Designation Review

In June 2016, EOEA performed a designation review of GSSSI’s Protective Services Program. EOEA performs these reviews every one to three years to ensure that designated PSAs comply with 651 CMR 5 and the applicable Massachusetts General Laws based on standards EOEA uses in conjunction with that regulation. The designation review reports show that these standards comprise the areas of intake, screening, investigation, ongoing services, documentation, and supervision. During its review, EOEA found that GSSSI’s investigations of abuse of elderly persons were not always conducted properly or in a timely manner and often lacked an appropriate level of supervision. EOEA also found that when it was determined that services would be provided based on abuse identified, GSSSI did not always develop service plans that addressed all areas of abuse. EOEA also determined that documentation often was not sufficient, clear, or completed in a timely manner.

As a result of the designation review, EOEA delayed GSSSI’s re-designation until management submitted a corrective action plan and demonstrated to EOEA that the Protective Services Unit was making improvements. GSSSI was re-designated in March 2018 as a result of a follow-up designation review.

Screening of Abuse Reports

On June 30, 2017, EOEA began operating a Centralized Intake Unit (CIU) to receive reports of abuse of elderly persons. The CIU operates 24 hours a day, seven days a week.² Once an abuse report has been received by a worker at the CIU, it is entered in APS and then sent as an intake to the PSA closest to where the incident took place.

Since the CIU was implemented, all PSAs, including GSSSI, have been required to ensure that all intakes of alleged abuse of elderly persons received from the CIU are evaluated, or screened, immediately by a protective service supervisor or designated backup supervisor. According to 651 CMR 5.09, screening requires a supervisor to “determine the immediacy and severity of the alleged harm or risk, and the appropriate initial response,” and the purpose of screening is “to determine whether the allegation constitutes a Reportable Condition” and “determine whether or not an Emergency, Rapid Response, or Routine response is needed.”

According to 651 CMR 5.02, reportable conditions include, but are not limited to, “abuse,” “physical abuse,” “sexual abuse,” “emotional abuse,” “neglect,” “self-neglect,” and “financial exploitation.”

The chart below shows the percentages of the four unique types of abuse allegations that were substantiated by GSSSI during the audit period.

 

If the supervisor determines that an emergency exists, s/he must immediately screen in the report and assign it for investigation. The emergency needs of the allegedly abused elderly person must be assessed within 24 hours after the report is received. If the supervisor determines that a report is related to a rapid response situation, s/he must immediately assign the report for investigation, and the needs of the elderly person must be assessed within 72 hours after the report is received. Finally, a routine response with a reportable condition, or non-emergency report, must be screened in within 48 hours of the receipt of the report. In all cases, the investigation must be completed within 30 calendar days.³ If the supervisor determines that there is no reasonable cause to believe⁴ that the allegations of abuse constitute a reportable condition, the report is screened out and not assigned for investigation. Reports that are screened out undergo expungement, a process that removes the report and any supporting information from APS one year and one day after they are entered in the system.

Investigations of Alleged Abuse

As a designated PSA, GSSSI is required to investigate information from reports of alleged abuse of elderly persons. Investigations include in-person visits to the residences of elderly persons who are the alleged victims of abuse and may include meeting with appropriate service 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,” referred to as collaterals. The law also states that if a PSA’s investigation determines that an elderly person is being abused, the PSA must “evaluate the elderly person’s functional capacity, situation, and resources” before developing a service plan (a written document that describes actions and services needed to prevent, alleviate, or eliminate the abuse of an elderly person).

At the conclusion of an investigation, if a caseworker determines that there is no reasonable cause to believe that a reportable condition exists, s/he concludes, with approval from a supervisor, that the allegations are unsubstantiated. This means that there is not sufficient evidence to conclude that the alleged abuse has occurred. Investigations of unsubstantiated allegations are subject to expungement from APS one year and one day after they and their supporting records are entered in the system. However, 651 CMR 5.12(1)(b) states that at the completion of an investigation, “where appropriate, the Protective Services Caseworker shall provide information and referral to the Elder regarding social, health, legal, or other services.”

Before January 13, 2017, when 651 CMR 5 was revised, elderly persons could refuse protective service investigations according to 651 CMR 5.11. However, as a result of the revision, elderly persons can no longer refuse investigations by protective service caseworkers. They can refuse to participate, but the PSA must still perform the investigation. After an investigation is conducted, an elderly person retains the right to refuse services (e.g., home care or Meals on Wheels) if s/he possesses the decisional capacity⁵ to do so.

Referrals to District Attorneys’ Offices

GSSSI investigates allegations of abuse in the greater Springfield area and must report investigations of substantiated, serious allegations of abuse to the district attorney’s (DA’s) office that covers the county where the abuse occurred. At the conclusion of an investigation, if an allegation of a reportable condition other than death is substantiated and meets the conditions of 651 CMR 5.19(2) for reporting to a DA, then GSSSI is required to submit a referral to the DA’s office within 48 hours of the determination. Under the version of 651 CMR 5.02 in effect before January 13, 2017, reportable conditions other than death that required a DA referral included, but were not limited to, “brain damage,” “fracture of a bone,” “sexual assault,” “symptoms resulting from the use of medications or chemical restraints,” “financial exploitation which involves possible criminal conduct,” and any other injury considered to be “non-trivial.” If it is determined that the elderly person died because of the abuse, GSSSI must make an immediate referral to a DA’s office. After a report of death, or a reportable condition other than death, has been filed, GSSSI must try to schedule a meeting with the DA’s office to discuss any future action to be taken in the case.

Service Plans

Once GSSSI has investigated and substantiated an allegation of abuse of an elderly person, a Protective Services Unit caseworker, in consultation with his/her supervisor, develops a service plan to provide protective services to the person. Service plans are developed based on the elderly person’s needs and describe the actions and services needed to eliminate or alleviate the abuse. These actions and services can be provided by caseworkers, caretakers, relatives, health service professionals, or others, depending on the elderly person’s needs. Recommended services can include, but are not limited to, home-delivered meals, personal care, and money management services. According to 651 CMR 5.02, service plans must clearly state the problems contributing to the abuse; include specific, measurable steps to address each problem; and address all findings of abuse identified during the investigation or the ongoing casework. GSSSI must reassess these service plans at least once during the first month of service and at least once every three months thereafter; it must update the service plans to reflect any changes made during these reassessments. According to 651 CMR 5.16, elderly persons who do not wish to receive protective services can refuse them, provided they have the decisional capacity to do so.

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

2.    Before this system was introduced, each designated PSA was responsible for receiving reports of abuse of elderly persons directly from the public during business hours, and the statewide Elder Abuse Hotline took reports that came in after business hours.

3.    In spring 2016, EOEA piloted and implemented a change that required EOEA approval of extensions of investigation deadlines related to allegations of abuse of elderly persons.

4.    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.”

5.    According to 651 CMR 5.02, decisional capacity is an elder’s ability to “understand and appreciate the nature and consequences of decisions . . . and . . . reach an informed decision while free from any apparent duress, intimidation, coercion, use of force, or threat of force by another.”

 

Date published:	September 4, 2019