STATE OF WEST VIRGINIA





UPDATE OF THE

FULL PERFORMANCE EVALUATION OF THE



ADULT PROTECTIVE SERVICES



OFFICE OF LEGISLATIVE AUDITOR

Performance Evaluation and Research Division

Building 1, Room W-314

State Capitol Complex



CHARLESTON, WEST VIRGINIA 25305

(304) 347-4890



May 1999



Issue Area 1: DHHR Made Marginal Improvement in Meeting the 3-Day Time Standard, However: the Time Standard was Changed from 3 Days to 14 Days.





This is a follow-up compliance review of Adult Protective Services (APS), as part of the Full Performance Evaluation of the Department of Health and Human Resources (DHHR). Last year the Legislative Auditor's Office reviewed APS for the first time. In a sample of 386 APS cases, the Legislative Auditor found that the agency interviewed alleged victims within the required 3 days in only 52% of the cases. This year's update of the original report reviewed 297 APS cases from five new counties and seven original counties that had the slowest response times last year. The results of this update showed that the agency contacted clients within 3 days in only 66% of the cases. This represents relatively marginal improvement.







































Time Standard Changed from 3 Days to 14 Days



The sample results of cases for 1997 and 1998 show that the agency has struggled to interview clients within the required 3 days. In November of 1998, a few weeks after the release of last year's report, DHHR changed its policy to require face-to-face contact with alleged adult victims from 3 days to 14 days, which is the same statutory requirement for Child Protective Services. The reason was stated by DHHR in its response to last year's report:



It is the position of the Department that this policy [3 day contact period] should be changed to be no more restrictive than that established under W.Va. Code 49-6A-9 for Child Protective Services. A policy which requires a 72-hour face-to-face contact for non-emergent referrals is unnecessary to the effective protection of these individuals. In addition, current funding levels are insufficient to provide the increased staff necessary to accomplish this requirement.





Table 1 shows the response times for individual counties in the sample. Except for Putnam county, the counties with the slowest response times last year showed significant improvement in 1998. However, despite the improvement, most of these counties were able to meet the 3-day time standard in less than 70% of the cases. The new counties met the 3-day time standard 60% to 95% of the cases.





TABLE 1

Average Number of Days to Conduct Face-to-Face Interviews

Percentage of cases in the Sample

Within 3 Days* Within 14 Days
Counties from First Review 1997 1998 1997 1998
Jackson 46% 61% 96% 95%
Mercer 34% 56% 63% 81%
Monongalia 37% 68% 75% 100%
Preston 62% 83% 78% 95%
Putnam 36% 32% 77% 86%
Summers 24% 63% 62% 100%
Taylor 57% 73% 93% 100%
New Counties Sampled in 1998
Brooke ---- 76% ---- 95%
Harrison ---- 62% ---- 92%
Mingo ---- 96% ---- 100%
Raleigh ---- 76% ---- 100%
Randolph ---- 77% ---- 100%
* Does not include referrals received after November 13, 1998 which required 14 day contact, per new policy. Only ten cases in the 1998 sample came under the new 14 day policy.





Clearly the agency has been unsuccessful in meeting the 3-day criteria (see Table 2). However, the agency has at times displayed difficulties in meeting the 14-day standard. In the review of 1997 cases, Mercer and Summers counties met the 14-day time standard in a little more than 60% of their cases, while Monongalia, Preston and Putnam met the standard in less than 80% of their cases (see Table 1).



Overall, the agency has been more successful in achieving the 14-day standard. Table 2 shows the response times from the 1997 and 1998 samples. In 1997, the counties reviewed contacted clients within 14 days in 86% of the cases. In 1998 the percentage increased to 96%. Ten of the twelve counties reviewed in 1998 met the 14-day standard in over 90% of their cases. The other two counties achieved the standard between 80 and 90 percent.





TABLE 2

Adult Protective Services

3 Day Versus 14 Day Time Standard

Year Sample Represents Percent of Cases with Contact Made Within 3 Days Percent of Cases with Contact Made Within 14 Days Average Number of Days to Make Contact
1997 Cases 52.0% 86.3% 6.0
1998 Cases 66.3% 95.2% 4.5
Source: From samples taken by the Legislative Auditor's Office of 1997 and 1998 APS cases.





Conclusion



Agency staff stated that changing the time standard to 14 days is a more realistic expectation. Cases that require faster response times can still be investigated in shorter time periods or under the emergency time standard of 24 hours. Survey results for 1998 cases show that the agency did well in meeting the 14-day time standard overall and on an individual basis.



Staffing levels do not appear to be a significant problem. Of the twelve counties reviewed this year, only one had a vacant position, and there was no appropriate correlation between staffing and the compliance rates (3-day or 14-day).



However, it should be pointed out that in the review of 1997 cases, several county offices would not have done well if the 14-day standard was in place. Although the review of 1998 APS cases showed good results, the same factors that affected 1997 performance could arise in the future. Some performance factors identified in the review of 1997 cases were management controls such as monitoring performance, high staff turnover rates, and the additional responsibilities of the Guardianship and Health Care Surrogate program. Furthermore, the staffing difficulties in Child Protective Services (CPS) can impact APS because sometimes APS workers are used to do CPS investigations. Regardless of what time standard is used, the agency needs to stabilize the APS system to ensure timely responses of alleged adult abuse and neglect.





Recommendation 1



The Department of Health and Human Resources should evaluate its resource needs to determine if adequate resources have been devoted to adult protective services to ensure proper response time for a growing elderly population. The Department also needs to evaluate ways to retain staff.





Recommendation 2



The agency should closely monitor APS investigations to assure that time requirements are being met.





Recommendation 3



The Legislature may wish to consider setting statutorily the appropriate time frame for interviews of alleged adult victims of abuse.