08/16/2006
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE:
August 22, 2006
TO:
Dotti Albury, Administrative Assistant
In-Home Services
Pamela G. Hanr~
Deputy Clerk 0
FROM:
At the August 16, 2006, Board of County Commissioner's meeting the Board granted
approval and authorized execution of the Memorandum of Understanding for APS (Adult
Protective Services) Referrals between Momoe County Board of County Commissioners
(In-Home Services), The Department of Children & Families and the Alliance for Aging (Aging
and Disability Resource Center/Aging Agency on Aging for Miami-Dade and Monroe Counties).
Enclosed are four duplicate originals of the above-mentioned, executed on behalf of
Momoe County, for your handling. Please be sure to return the fully executed "Monroe
County Clerk's Office Originals" and the "Monroe County Finance Department's Originals"
as soon as possible, Should you have any questions please do not hesitate to contact this office.
cc: County Attorney
Finans;e w/o document
File'v'
MQfOOComdy~s~~
AGING AND DISABILITY RESOURCE CENTER/ AGING
RESOURCE CENTER /AREA AGENCY ON AGING
And
THE DEPARTMENT OF CHILDREN AND FAMILIES
And
COMMUNITY CARE FOR THE ELDERLY CASE MANAGEMENT
AGENCY
MEMORANDUM OF UNDERSTANDING FOR APS REFERRALS
. .. 16th August
This Memorandum of Understanding, made this day of , 200:6,
shall be in effect indefinitely between the Alliance for Aging, Inc., the Aging and
Disability Resource Center/Aging Resource Center/Area Agency on Aging for
Planning and Service Area 11; Monroe County In-Home Services, the Community
Care for the Elderly case management agency; and the Department of Children and
Families for referrals made in Monroe county.
Objectives
1. To maintain a climate of cooperation between agencies in order to achieve
equitable delivery of services to vulnerable elder Floridians in need of
services or victims of abuse, neglect, or exploitation.
2. To promote services and activities designed to protect vulnerable elders and
prevent premature institutionalization, pursuant to Chapters 415 and 430,
Florida Statutes.
3. To participate together by means of shared information in tracking delivery of
services to victims of abuse, neglect, exploitation, or vulnerable elders in
need of services.
4. To provide technical assistance and consultation to each other on matters
pertaining to actual service delivery and to share appropriate assessment
information and care plans.
Page 1 of 11
Definition of Terms
. "Abuse," as defined in s. 415.102 (1) F.S., means any willful act or
threatened act by a caregiver that causes or is likely to cause significant
impairment to a vulnerable adult's physical, mental, or emotional health.
Abuse includes acts and omissions.
· "Neglect," as defined in s. 415.102 (15) F.S., means the failure or omission
on the part of the caregiver to provide the care, supervision, and services
necessary to maintain the physical and mental health of the vulnerable adult,
including, but not limited to, food, clothing, medicine, shelter, supervision, and
medical services, that a prudent person would consider essential for the well-
being of a vulnerable adult. The term "neglect" also means the failure of a
caregiver to make a reasonable effort to protect a vulnerable adult from
abuse, neglect, or exploitation by others. "Neglect" is repeated conduct or a
single incident of carelessness, which produces or could reasonably be
expected to result in serious physical or psychological injury or a substantial
risk of death.
· "Exploitation," as defined in s. 415.102 (7) F.S., means a person who
o Stands in a position of trust and confidence with a vulnerable adult and
knowingly, by deception or intimidation, obtains or uses, or endeavors
to obtain or use, a vulnerable adult's funds, assets, or property with the
intent to temporarily or permanently deprive a vulnerable adult of the
use, benefit, or possession of the funds, assets, or property for the
benefit of someone other than the vulnerable adult; or
o Knows or should know that the vulnerable adult lacks the capacity to
consent, and obtains or uses, or endeavors to obtain or use, the
vulnerable adult's funds, assets, or property with the intent to
temporarily or permanently deprive the vulnerable adult of the use,
benefit, or possession of the funds, assets, or property for the benefit
of someone other than the vulnerable adult.
Page 2 of 11
"Exploitation" may include, but is not limited to:
o Breaches of fiduciary relationships, such as the misuse of a power of
attorney or the abuse of guardianship duties, resulting in the
unauthorized appropriation, sale, or transfer of property;
o Unauthorized taking of personal assets;
o Misappropriation, misuse, or transfer of moneys belonging to a
vulnerable adult from a personal or joint account; or
o Intentional or negligent failure to effectively use a vulnerable adult's
income and assets for the necessities required for that person's
support and maintenance.
· "Vulnerable adult," as defined in s. 415.102 (26) F.S., means a person 18
years of age or older whose ability to perform the normal activities of daily
living or to provide for his or her own care or protection is impaired due to a
mental, emotional, long-term physical, or developmental disability or
dysfunction, or brain damage, or the infirmities of aging.
· "Vulnerable adult in need ofservices," as defined in s. 415.102 (27) F.S.,
means a vulnerable adult who has been determined by a protective
investigator to be suffering from the ill effects of neglect not caused by a
second party perpetrator and is in need of protective services or other
services to prevent further harm.
· "Further Harm" is when a vulnerable adult is expected to suffer ill effects
from additional or continued maltreatment(s) of neglect without the provision
of services. The potential for further harm will be inferred by the closure of a
report as a "vulnerable adult in need of services"; or the closure of a second
party report with one or more maltreatment findings of "Some Indicators" or
"Verified" AND the protective investigator's initial assessment of risk of the
victim is "high."
Page 3 of 11
. "III effects of neglect" exist when a protective investigator determines that a
vulnerable adult is suffering some degree of harm or injury or that there is a
reasonable expectation of harm or injury directly resulting from neglect.
. "Protective services," as defined in s. 415.102 (20) F.S., means services to
protect a vulnerable adult from further occurrences of abuse, neglect, or
exploitation. Such services may include, but are not limited to, protective
supervision, placement, and in-home and community-based services.
· "Protective supervision," as defined in s. 415.102 (21) F.S., means those
services arranged for or implemented by the Department of Children and
Families to protect vulnerable adults from further occurrences of abuse,
neglect, or exploitation.
· "Intake Entity" is the agency to which DCF sends DCF's Adult Protective
Services (APS) referrals. There may be more than one intake entity in a
county. Each Planning and Service Area's Aging and Disability Resource
Center/Aging Resource Center/Area Agency on Aging (ADRC/ARC/AAA)
determines which agency(ies) will be the intake entity(ies) for APS referrals in
each county in their Planning and Service Area. ADRCs/ARCs/AAAs acting
as the intake entity are responsible for notifying and transferring the
appropriate documentation to the ADRC/ARC/AAA designated Community
Care for the Elderly (CCE) case management agency (hereinafter referred to
as the CCE Lead Agency) when services are needed.
Identify the intake entity(ies) below.
All APS referrals, regardless of risk level will be sent to the following agency:
r ADRC/ARC/AAA rj:.. CCE Lead Agency
OR
All "high" risk APS referrals will be sent to the following agency:
if'"' ADRC/ARC/AAA 'Ii:' CCE Lead Agency
Page 4 of 11
All "intermediate" risk APS referra
r ADRC/ARC/AAA
All "low" risk APS referrals will
r ADRC/ARC/AAA
be sent to the following agency:
.~. CCE Lead Agency
t to the following agency:
r CCE Lead Agency
Under this Memorandum of Understanding, the ADRC/ARC/AAA, CCE Lead Agency,
and Department of Children and Families agree to the following:
1. Each Planning and Service Area's ADRC/ARC/AAA determines which
agency(ies) will be the intake entity(ies) for DCF's Adult Protective Services
(APS) referrals in each county in their Planning and Service Area. All APS
referrals in need of home and community-based services will be sent to the
appropriate intake entity in the county in which the APS referral resides.
2. If the person who is the subject of the APS referral needs immediate
protection from further harm, the referral will be designated as "high-risk" and
will be staffed by APS and the ADRC/ARC/AAA designated Community Care
for the Elderly (CCE) case management agency (hereinafter referred to as
the CCE Lead Agency) to determine the need for specific services to avert a
crisis or stabilize the situation. Such services will be time limited and must be
designed to abate the emergency or crisis situation that places the person at
risk of further harm. The CCE Lead Agency must initiate the emergency or
crisis resolving service(s) within 72 hours of referral. This includes services
recommended by APS, but not currently provided. Case management alone
does not meet this requirement. For consumers who are currently receiving
DOEA funded services, and who are referred by APS, the 72-hour time frame
includes not only those existing services, but also any additional emergency
or crisis resolving service(s) requested by APS. The provision of services
shall not exceed 30 days unless APS and the CCE Lead Agency jointly agree
the emergency or crisis still exists, and that continuation of the services are
necessary to stabilize the person's situation. APS staff must advise
consumers upon referral that services will be time-limited up to 30 days.
Page 5 of II
Upon receipt of the referral, the CCE Lead Agency must clearly communicate
to the consumer that services are limited to 30 days. Notification of services
extending beyond 30 days will be provided to the ADRC/ARC/MA by the
CCE Lead Agency prior to the 30th day.
3. When the vulnerable adult is no longer in danger of harm as determined
jointly through an APS and CCE Lead Agency staffing, he or she may apply
for DOEA-funded services based on DOEA guidelines. The provision of these
services will be based on DOEA prioritization criteria.
4. Emergency or crisis resolving services should begin as requested by the APS
Protective Investigator's recommendations. If at any time during the process
there are any disagreements between the APS Protective Investigator and
the CCE Lead Agency regarding services to be provided, the APS Protective
Investigator Supervisor and a Case Manager Supervisor at the CCE Lead
Agency will jointly review the case to resolve the issues. The CCE Lead
Agency will forward notes from the weekly joint staffing sessions held with
APS to the ADRC/ARC/AM if requested to do so. If the issue(s) cannot be
resolved at this level, the case will be referred to the ADRC/ARC/AM and the
DCF district office for final resolution.
5. All APS referrals made during business hours will be entered into the APS
Referral Tracking Tool (ARTT) the day the referral to the intake entity is
made.
6. Within three hours of entering the referral into the ARTT, a referral packet will
be sent via fax or hand delivered to the intake entity. A referral packet will
include the following:
· DCF Form 1099 printed from the ARTT, if the ARTT is available at the
time of referral,
· Capacity to Consent Assessment,
· Adult Safety Assessment of Safety Factors, and
Page 6 of ] 1
. Adult Safety Assessment of Overall Safety, and
. Court Order, if services were court ordered.
7. Only an APS Protective Investigator with the approval of an APS Protective
Investigator Supervisor, or APS Protective Investigator Supervisor can initiate
APS referrals.
8. APS "high-risk" referrals made after business hours require a telephone call
to the intake entity. The following referral information must be provided:
name, social security number, address, service assessment, risk factors
(such as environmental concerns), and type of report. The referral will be
entered into the ARTT within the first three hours of business the following
day. Within three hours of entering the referral into the ARTT, a referral
packet will be sent via fax or hand delivered to the intake entity (see #6 above
for packet contents).
9. Only referrals for clients age 60 and older will be sent to the intake entity and
entered into the ARTT.
10. The intake entity will confirm receipt of a faxed referral by contacting the DCF
office via telephone or email. Email messages must only refer to the abuse
report number and must not include the name or social security number of the
referral.
11. APS referrals for home and community-based services are not limited to
Community Care for Elderly or Home Care for the Elderly services, and may
include non-DOEA funded services coordinated by the CCE Lead Agency.
12. If the ARTT is not available at the time of referral, a DCF Form 1099 will be
manually completed. When the ARTT becomes available, the referral will be
entered into the ARTT.
Page 7 of 11
13. An APS referral initially sent to APS Protective Supervision that is later
referred to the intake entity will be entered into the ARTT.
14. Each referral will be entered separately into the ARTT. If services are being
requested for more than one member in a household, separate referrals will
be entered into the ARTT.
15. Only APS referrals for victims of abuse, neglect, exploitation and vulnerable
adults as identified by APS staff will be put into the ARTT.
16. All APS referrals, regardless of risk level (i.e., high, intermediate, or low), will
be entered into the ARTT.
17. If a new abuse report (number) is received for an individual who had been
reported and referred previously, a new referral will be entered into the ARTT,
regardless of whether or not the individual is currently receiving services.
18. The intake entity must acknowledge receipt of the APS referral in the ARTT
the same day the referral packet is received.
19. The CCE Lead Agency will enter the case status in the "Action Taken by
Provider" field (#30) and/or the "Staffing or Additional Comments" field (#31)
in the ARTT, along with the "Service Provider's Signature" (#36). The
"Schedule Staffing Date" (#37) must be entered into the ARTT within 72 hours
from the time the referral packet is received for "high- risk" referrals and within
ten business days for "intermediate" and "low" risk referrals, if the referral is
accepted.
20. The intake entity will work together with APS staff to identify and maintain, in
accordance with law, accurate social security numbers should the two
agencies have different social security numbers for the same individual.
Page 8 of 11
21. A 701 B comprehensive assessment must be completed within 72 hours for
"high-risk" referrals and in accordance with Department of Elder Affairs policy
for "intermediate" and "'ow" risk referrals.
22. CCE co-payments for services will be waived for APS referrals during the first
30 days of service or until the vulnerable adult's crisis situation has stabilized.
23. The following information will be entered in the Client Information and
Registration Tracking System (CIRTS) for all APS referrals:
. Assessment information; must include the referral date, referral
source set to Abuse/Neglect, and risk level (high, intermediate, low),
. Enrollment information,
. Care plan information, and
. Units of service provided.
24. APS "high-risk" referrals must have the following information entered in
CIRTS:
· Units of service for case management and core type services are
entered using the date specific method for the first month. This
includes Older Americans Act services that may normally be reported
in aggregate. After the initial month, CCE Lead Agencies may return to
entering aggregate units.
· For current consumers referred by Adult Protective Services and
determined "high-risk," the date of service delivery and units of
service are entered as if the client were a new "high-risk" referral, Le.,
date specific.
· Informal services arranged by the case manager, Le., churches,
neighbors, or other community resources, are entered in CIRTS on
the Services Received Screen for the month the service is provided.
The code is Non-Department of Elder Affairs Programs (NDP). The
service is listed as "Other" and the unit is one episode with no unit
cost. Specific information about the informal service(s) should be
contained in the file on the hard copy of the care plan.
Page 9 of 11
25. If the person who is the subject of the APS referral refuses to be assessed or
there is a delay in service provision for reasons beyond the control of service
providers, the CCE Lead Agency will do the following:
. Contact the APS investigator to discuss the situation and determine
the next best course of action. If the referral is a "high-risk" referral,
APS must be contacted within 24 hours.
· Create an entry in the Received Services screen in CIRTS with Case
Management as the Service with the appropriate date and units if
case management services were provided.
· "High-risk" referrals require an additional entry in the CIRTS Received
Services screen identifying the reason for the delay in service
provision. The Program is set to "NOP" and one of the following
codes is listed as the Service:
o PLHS - Placed in hospital
o PLNH - Placed in nursing home
o PLAF - Placed in ALF
o PLFM - Placed with family
o CLRF - Consumer refused
o CLUV - Consumer unavailable; cannot be located
o CLOC - Consumer deceased
The number of units should be set to "0" and the unit type set to EPS.
26. The AORC/ARC/AAA will run CIRTS reports monthly to compare referral dates
with services received dates to ensure compliance with the 72-hour statute.
Page 10 of 11
(6)k&
Signature
President/CEO
Title
Pedro Jove
Printed Name
Alliance for Aging, Inc.
ADRC/ARC/AAA
roJ~)dp
Date (
a
Signature
Mayor
Title
Charles "Sonny" McCoy
Printed Name
Monroe County In-Home Services
CCE Lead Agency
8-16-2006
Date
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Page 1 ] of 11