Objective

To determine if the Office of Children and Family Services adequately monitors Adult Protective Services activities to protect vulnerable adults. The audit covered referrals received for the period from April 2017 through December 2020 and the relevant work completed through April 2021.

About the Program

In New York State, the Office of Children and Family Services (OCFS) administers the Adult Protective Services (APS) program to assist vulnerable adults. APS is a program of State-mandated services for adults (over age 18) who, because of mental or physical impairments, are unable to meet their essential needs (e.g., food, shelter, clothing, medical care); are in need of protection from abuse, neglect, financial exploitation, or other harm; or have no one available who is willing and able to assist them responsibly. Services provided range from safety monitoring, linkages with other service providers (e.g., health, mental health, aging), and assistance in obtaining benefits to informal money management and court petitions to appoint a guardian or other legal intervention.

Within OCFS, the Bureau of Adult Services (Bureau) oversees local APS programs statewide. OCFS’ network of APS providers is composed of several categories of entities: the 57 county Local Districts of Social Services and the St. Regis Mohawk Tribe Department of Human Services, responsible for APS referrals outside of New York City (rest of State, or ROS); and 10 field offices and/or contractors in New York City, responsible for APS referrals in the five boroughs. (Hereafter, these entities are collectively referred to as APS providers.)

According to research published in 2020,¹ each year about 1 in 10 older adults (age ≥ 60 years) in the United States experiences elder abuse, including physical, sexual, or psychological abuse, as well as financial exploitation or neglect by caregivers. Elder abuse also often goes undetected; only 1 in 24 cases are identified and reported to the proper authorities.

Once a referral is received, the APS provider is responsible for assessing the adult’s needs and risk of harm, which may also require coordination with law enforcement and other agencies. Where the APS provider determines that services (e.g., counseling; coordination of services delivery, such as Meals on Wheels; securing alternative living arrangements) are necessary, they must take action to provide the services voluntarily, and services should be as least restrictive as possible. OCFS’ policy requires APS providers to sufficiently document the assessment of the client’s needs, their due diligence in helping the client obtain services, and if services were not warranted, the reasons why. To ensure that APS activities meet State standards, the Bureau conducts Practice Reviews (Reviews) of each APS provider.

OCFS uses two systems to record APS referrals and monitor APS providers’ actions: Adult Protective Services Net (APSNet) for New York City referrals and Adult Services Automation Project (ASAP) for ROS referrals. According to APSNet and ASAP data, for the period April 1, 2017 through December 31, 2020, New York City received 102,687 unique referrals (i.e., excluding duplicate referrals of the same individual), and the ROS received 82,995 unique referrals.

Key Findings

• OCFS does not effectively monitor APS providers and their activities to ensure vulnerable adults are protected and receive the services they need. While OCFS had established processes, as well as policies and procedures, to review APS activities, it does not always ensure these processes are being executed as required. For instance, we found that, for a sample of Reviews—which Bureau management stated they rely on to help them determine the training and technical assistance needs of a given APS provider—many were not conducted timely, did not contain all required information critical to an accurate assessment, and lacked documentation that deficiencies were followed up on. Further, the policies and procedures lacked explicit guidance on critical aspects of the Review process, including the target time frames for conducting Reviews (i.e., every 3–4 years), the follow-up of APS providers regarding deficiencies and program improvement plans, and documentation of these efforts.
• Generally, APS providers’ case file documentation for referrals sufficiently explained clients’ risks and needs, supported their assessment to either open or close a referral, and supported the need for the specific services provided to the clients. However, progress notes were not always entered into the case files within the required 30-day time frame and thus may not have captured the most accurate or detailed record of client events to ensure that APS activities and services are appropriate and that clients’ needs are being met.

Key Recommendations

• Revise existing policies and procedures to include written guidance on the frequency of Reviews as well as practices for following up on and documenting that deficiencies have been corrected.
• Work with APS providers to improve case file documentation, including ensuring case notes are sufficiently detailed and entered timely to ensure that required visits are made to adequately assess the needs of the clients.