Adult Protective Services (APS) and Residential Care Services (RCS) has released their proposal for restructuring their investigation process and the division of agency responsibility. 

LeadingAge WA and other stakeholders attended a meeting held by RCS and APC last Fall.  During this meeting, it was announced that both divisions agreed to move forward with changes to their investigation screening criteria. RCS will now be the initial investigator in all licensed facility complaints unless it is an abuse or sexual misconduct complaint concerning an individual. LeadingAge met with both APS and RCS numerous times to express concerns over having both entities performing investigations at the same time in facilities and APS alone performing an investigation in a licensed care facility.

Our biggest concern has been the “double jeopardy” and staff time involved in having two separate investigations for one incident, this practice is duplicative.  Dual investigations by different entities has also caused confusion. These findings have, at times, led to administrators and Directors of Nursing being found guilty of neglect which can result in a ban on their ability to work with vulnerable adults. Because APS does not have the same appeal process that RCS or DOH has, these findings are considered to be particularly harsh.  Typically, when DOH takes action against a license, there are different degrees of actions that vary in severity.  When APS finds an individual guilty of abuse or neglect resulting in their name on the registry, currently, there is no mechanism for their name to be removed. However, APS is currently working to change this through legislation.

Our other concerns relate to the overall misunderstanding and confusion of which entity was lead on the investigation in a facility. LeadingAge WA has provided webinars for providers to help understand the role of each agency and why they may both be investigating a complaint.

Below are the final proposal for the changes. I encourage all members to review the proposal and let us know if you have questions or concerns. Currently, there is not a set implementation date as APS and RCS still have multiple details left to figure out. Once the new process has been implemented they will be providing an update after 6 months. It is important that if any issues or concerns come up with the new investigation process that members share those with us. We will report all the information back to DSHS.

Chapter 74.34 RCW

Background: APS and RCS are both divisions with Aging and Long-Term Support Administration (ALTSA) within the Department of Social and Health Services (DSHS).  In department licensed or certified facilities or programs, an APS investigation is focused on the individual alleged perpetrator who may have abandoned, abused, neglected or exploited a vulnerable adult and APS makes a finding regarding that individual alleged perpetrator (allegation substantiated or unsubstantiated).  An RCS investigation is focused on the actions of the provider and provider practice and may impose remedies against the provider if compliance violations are found.  These are two very different and distinct investigations.

In October 2014, the Secretary of ALTSA, Bill Moss, made the decision to move the Resident and Client Protection Program (RCPP), formerly under the RCS Division, to the APS program which was at the time within the Home and Community Services Division (APS became its own division on July 1, 2019).  Stakeholder focus groups were held and input was gathered; timely response and person-centered investigations were paramount in the decision to transition this work in 2014.

In 2017 APS and RCS collaborated with stakeholders on revising the APS screen-out policy to reduce instances of simultaneous, multiple investigations in facilities.  Amendments included APS screening out certain medication errors, observed falls, isolated (singular) incidents of physical or mental abuse that resulted in no/isolated injury, unreasonable confinement, intimidation or punishment, and financial exploitation of nominal value (for example a resident eating another residents candy).  APS will screen those reports out as ‘other investigation jurisdiction,’ and refer those reports to RCS for a priority review and investigation.  The amendments were effective January 2018.

APS and RCS are re-evaluating intake processes and investigations to reduce redundant investigations in facilities and agencies regulated by RCS. This paper provides an overview of division purposes, a proposal and implementation plan.

Purpose: Chapter 74.34 RCW requires the department to initiate a response to allegations of vulnerable adult mistreatment and to offer protective services.  The department has discretion on how to implement these duties under the statute in its administrations/divisions through its policies. 

APS and RCS have continued to meet with stakeholders to discuss concerns around the separate investigations and the presence of both divisions in facilities.  Stakeholders continue to cite facility staff confusion about the two different investigations, facility disruption and limited remedies available to APS by statute.  Additionally, there is a concern for the burden of multiple investigations for the victims of alleged abuse.  The administration has been working on additional screening criteria to provide a more streamlined process, while ensuring the continued protection of vulnerable adults, a person-centered approach, and timely response.  

Proposal:

RCS

1. If a report is first made to RCS they will initiate a response to those allegations in accordance with RCS screening criteria as they relate to allegations against an owner, volunteer, administrator, resident or an employee of a department licensed facility or certified program.
   • RCS-Complaint Resolution Unit (CRU) will refer to APS all reports involving physical and sexual abuse allegations.
   • RCS-CRU will continue to refer all reports to APS where the alleged perpetrator is not affiliated with the facility/certified program.
2. If RCS finds during the course of their provider practice investigation that abandonment, abuse, neglect, or financial exploitation (per RCW 74.34) by a volunteer, administrator, employee, owner, or a resident is suspected, they will make a referral to APS to screen for an investigation.

APS

1. If APS receives a report regarding alleged victim in a DSHS licensed facility or certified program, then APS will first check databases to see if RCS already has a report:
   • Subject to (2), if both APS and RCS received the report with the same subjects and same allegation(s), APS will screen out the report as ‘other investigative jurisdiction’ (RCS) documenting appropriately.
   • If no report exists with RCS, APS will screen out the report as ‘other investigative jurisdiction’ (RCS) and make a referral to RCS-CRU, documenting appropriately.
2. APS will screen all reports of alleged physical and sexual abuse and will assign such reports for an APS investigation.
3. APS will continue to investigate reports where the vulnerable adult resides in a department licensed facility or certified program and the alleged perpetrator is not affiliated with the facility (not a volunteer, administrator, employee, owner, or a resident).

Implementation:

1. Policy changes to RCS Standard Operating Procedures and APS policy are necessary to reflect the above process and amend as necessary to maintain efficiencies and the streamlined procedure.
2. APS and RCS will conduct a WAC review to determine if amendments are necessary.
3. APS and RCS will monitor this policy change and meet regularly to discuss.
4. APS and RCS will assess workload impact and make necessary staffing changes.
5. On-Line Reporting tool will be enhanced to reflect changes.

Questions:

Alyssa Odegaard- Vice President, Public Policy, LeadingAge Washington

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