10/16/2002
Clerk If 1IIe
Circul clun
Danny L. Kolhage
Office (305) 292.3550 Fax (305) 295-3663
Memorandum
To:
Louis LaTorre, Director
Social Services
Attn:
Dotti Albury, Administrative Assistant
In-Home Services Program
Isabel C. DeSantis, . fi J
Deputy Clerk JJ-AT
From:
Date:
Friday, December 06, 2002
At the BOCC meeting of October 16, 2002, the Board approved the following:
/Memorandum of Agreement for APS Referrals between Alliance for Aging, Inc.
for Planning Service Area 11; United Home Care Services, Inc.; Miami Jewish Home and
Hospital for the Aged; First Quality Home Care, the Community Care for the Elderly
Lead Agencies for Miami-Dade County; Monroe County Social Services, the Community
Care for the Elderly Lead Agency for Monroe County; and the Department of Children
and Families to promote the development of a coordinated service delivery system to
meet the needs of consumers who are referred by Protective Investigators to
Community Care for the Elderly Lead Agencies.
Attached are three (3) fully executed duplicate original ofthe above for your
handling.
Memorandum of Agreement for CARES Referrals between the Alliance for
Aging, Inc. the Area Agency on Aging for Planning Service Area 11; United Home Care
Services, Inc.; Douglas Gardens Community Care; First Quality Home Care, the
Community Care for the Elderly Lead Agencies for Miami-Dade County; Monroe County
Social Services, the Community Care for the Elderly Lead Agency for Monroe County;
and the Department of Elder Affairs - CARES to promote the development of a
coordinated service delivery system to meet the needs of consumers who are referred by
CARES.
Attached are five (5) duplicate originals of the subject document for your
handling. Please be sure that both the Clerk's and Finance Orhdnals are returned
to this office as quickly as possible. Should you have any questions, please do not
hesitate to contact this office.
cc: Finance, APS only
County Attorney
File../"
AREA AGENCY ON AGING
DEPARTMENT OF CHILDREN AND FAMILIES
COMMUNITY CARE FOR THE ELDERLY LEAD AGENCIES
MEMORANDUM OF AGREEMENT FOR APS REFERRALS
This Memorandum of Agreement, made this 30th day of June, 2002, shall be in effect indefinitely
between the Alliance for Aiini- the Area Aiency on Aiini for Plannini and Service Area 11; and
United Home Care Services Inc., Miami Jewish Home and HosJ>ital for the Aged and First Quality
Home Care, the Community Care for the Elderly Lead Agencies for Miami-Dade County, Monroe
County Social Services, the Community Care for the Elderly Lead Agency for Monroe County,
and the Department of Children and Families. The purpose of this agreement is to promote the
development of a coordinated service delivery system to meet the needs of consumers who are
referred by Protective Investigators to Community Care for the Elderly Lead Agencies. These
services are authorized in order that the consumer may remain in the least restrictive setting and
avoid or delay premature nursing home placement to the maximum extent possible.
Procedures are in place for the Department of Children and Families to refer Adult Protective
Services consumers to Community Care for the Elderly Lead Agencies. Providers have been
given copies of the A-PS Policy 98-IR "Vulnerable Adult in Need of Services," developed by the
Department of Children and Families, with an implementation date of October 1, 1998.
This document was used to formulate the following requisites:
A. Objectives
1, To maintain a climate of cooperation between agencies in order to achieve equitable
delivery of services to frail and vulnerable elder Floridians,
2. To promote services and activities designed to protect vulnerable elders and prevent
premature institutionalization, pursuant to Chapters 415 and 430, Florida Statutes.
Page 1 of 10
3. To participate together by means of shared information in the development and
expansion 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.
B. Definition of Terms.
1. "Abuse"
Abuse means any willful act or threatened act that causes or is likely to cause
significant impairment to a vulnerable adult's physical, mental, or emotional health.
Abuse includes acts and omissions.
2. "Neglect"
Neglect 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.
3. "Exploitation"
Exploitation means a person who:
1. 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
Page 2 of 10
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
2. 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.
"Exploitation" may include, but is not limited to:
a . 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;
b. Unauthorized taking of personal assets;
c. Misappropriation, misuse, or transfer of mOl).eys belonging to a vulnerable
adult from a personal or joint account; or
d. 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.
4. "Vulnerable Adults in Need of Services"
A vulnerable adult in need of services is an adult who:
. Meets the statutory definition of a vulnerable adult: AND,
Page 3 of 10
. Is suffering from the ill effects of neglect not caused by a second
perpetrator, as determined by a protective investigator: AND,
. Is in need of protective services or other services to prevent further harm.
5. "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 wit h one or more maltreatment findings
of "Some Indicators" or "Verified" AND the protective investigator's initial assessment of
risk of the victim is high.
6. "Dl effects of neglect"
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 reasonable expectation of harm
or injury directly resulting from "neglect" as defined in s. 415.102 (15), F.S.
7. Protective Services to Prevent Further Abuse, Neglect, or Exploitation" The
provision or arrangement of services for a vulnerable adult to protect from further
occurrences of abuse, neglect, or exploitation caused by a second party. Such services
may include, but are not limited to, protective supervision, placement, and in-home and
community-based services.
8. "Protective Services to Prevent Further Harm"
The provision or arrangement of services for a vulnerable adult in need of services to
protect from further ill effects of neglect not caused by a second party, Such services may
include, but are not limited to, protective supervision, placement, and in-home and
community-based services.
Page 4 of 10
9. "Protective Supervision"
Protective Supervision is a component of the Adult Services Program and is a
responsibility of a Protective Supervision Counselor with the department.
Protective Supervision includes those services arranged for or implemented by the
department to protect vulnerable adults from further occurrences of abuse, neglect, or
exploitation. [s. 415.102(21), F. S.]. Protective Supervision for victims of abuse, neglect,
or exploitation may be initiated during or at the close of an investigation/assessment and
the need for services has been established by the protective investigator.
Protective Supervision also includes those services arranged or implemented by the
department to protect vulnerable adults in need of services from further ill effects of
neglect not caused by a second party perpetrator. These services may be provided during
an assessment or following closure of an assessment in which a vulnerable adult has been
determined by a protective investigator to be in need of services. Protective Supervision
for vulnerable adults in need of services can be provided when:
. the victim of neglect lacks the capacity to consent; or,
. the victim has capacity to consent and does consent.
c. Under this Agreement, the Service Provider Agency, the Department of Children
and Families, and Area Agency on Aging agree to the following:
1. All Adult Protective Services (APS) referrals in need of home and community-
based services will be sent to the Area Agency on Aging designated Community
Care for the Elderly (CCE) Lead Agencies, using DCF form 1099 which identifies
the individual's risk level - High, Intermediate, or Low. The referrals may be sent
by fax, hand delivered, or given over the telephone, followed up with a DCF 1099
form. The Adult Protective Investigator must follow-up the oral referral with a
Page 5 of 10
written referral the next business day. Provide a referral packet which will include
the written referral, a copy of the capacity to consent evaluation and a copy of the
initial risk assessment. (See Attachment I for Local Protocol)
2. If the APS referral needs services for immediate protection from further harm, the
referral will be designated as "high" and will be staffed by the DCF and the Area
Agency on Aging designated CCE Lead Agency case managers to deter-mine 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.
3. The Area Agency on Aging designated CCE Lead Agency must initiate services
within 72 hours of referral. All requested services must begin within 72 hours for
"high" risk referrals. This includes services recommended by the Department of
Children and Families, but not currently provided by the Lead Agency. Case
management alone does not meet this requirement. For current consumers-who
are referred by Adult Protective Services, the 72-hour time frame includes not only
existing services, but also any additional services requested by Adult Protective
Services. The provision of services shall not exceed 30 days, unless DCF and the
Area Agency on Aging designated CCE Lead Agency staff jointly agree the
emergency or crisis still exists, and that continuation of the services provided 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. Upon receipt of
referral, the case management agency must reiterate to the consumer that services
are limited to 30 days.
If a required service cannot be delivered within this time frame, arrangements
should be made to have the service delivered as soon as possible 'thereafter.
Efforts to this effect will be documented in the consumer case file.
Page 6 of 10
4. A comprehensive assessment must be completed within 72 hours for "high" risk
referrals and in accordance with Department of Elder Affairs policy for
Intermediate and Low Risk referrals.
5. The Lead Agency must send a response regarding the case status to the
Department of Children and Families. This response is entered on form 1099,
page 2, number(s) 31 and/or 32. The Lead Agency supervisor signs and dates on
line 37 and returns the form to the Department of Children and Families with a
copy to the Area Agency on Aging. The response time is 72 hours for "high" risk
referrals and within two weeks for "Intermediate" and "Low" risk referrals.
6. If, at any time during the process, there are any disagreements between the DCF
Protective Investigator and the Area Agency on Aging designated CCE Lead
Agency Case Manager regarding services to be provided, the DCF Protective
Investigator Supervisor and the CCE Lead Agency Case Manager Supervisor will
jointly review the case to resolve the issues. If the issues cannot be resolved at
this level, the case will be referred to the Area Agency on Aging and the DCF
District Office for final resolution.
7. When the vulnerable adult is no longer in danger of harm as determined jointly
through a DCF / Area Agency on Aging designated CCE Lead Agency staffing,
he/she may apply for CCE, Medicaid Waiver or other DOEA-funded services
based on DOEA guidelines. The provision of these services will be based on
DOEA prioritization criteria.
8. CCE co-payments for services will be waived for APS referrals during the first 30
days of service, or until the vulnerable crisis situation has stabilized.
Page 7 of 10
9. In addition, Adult Protective Services referrals with a "high" risk level 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, 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, i.e., date specifically.
. Informal services arranged by the case manager, i.e., churches, neighbors,
or other community resources, are entered in CIR TS 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.
. NDP will be used for high risk Adult Protective Services consumers only.
. Specific information about the informal service(s) should be contained in
the file on the hard copy of the care plan.
10. The following information will need to be entered in CIRTS for all Adult
Protective Services referrals:
. Assessment/Care Plan/Enrollment information
. Referral Date.
. Referral source code, A (AbuselNeglect).
. Risk level (High, Medium, Low).
. Units of service.
Page 8 of 10
11. DCF staff agree to submit to the Area Agency on Aging, copies of ALL referrals
being sent to the CCE Lead Agency from Adult Protective Services regardless of
High, Intermediate, or Low status. All Adult Protective Services referrals will be
logged and tracked by the Area Agency on Aging.
12. Ifit is determined that a consumer is currently receiving services from the Lead
Agency, a courtesy telephone contact will be made by DCF with the Lead Agency
in addition to the written referral when feasible.
13. If the consumer refuses services after the CCE Case Manager has completed the
assessment or refuses to be assessed and no services are started, the CCE Lead
Agency will enter the information obtained in the Client Information Registration
Tracking System (CIRTS), using Provider Service Area specific site. Case
management will be opened for one day and terminated the next using the
appropriate code. The CCE Lead Agency will contact the APS Investigator to
discuss the situation and determine the next best course of action.
14. If there is a delay in service provision for reasons beyond the control of service
providers, DCF shall be notified. Codes have been established to capture this
information in CIR TS:
PLHS Placed in hospital
PLNH Placed in nursing home
PLAF Placed in ALF
PLFM Placed with family
CLFR Consumer refused
CLDC Consumer deceased
Page 9 of 10
15. Services should be started as requested following the Adult Protective Services
referral procedures. Any disagreements should be handled through the review and
staffing process.
16. The Area Agency on Aging will run CIRTS reports monthly to compare referral
dates with services received dates to ensure compliance with the 72-hour statute.
ALLIANCE FOR AGING, INC.
DEPARTMENT OF CHILDREN AND
FAMILIES
1 {'l-l~~
~~
Signature
i)J'.f-I'4t::/- ~h~
Title
//t~~
-'
Date
~ U-/~
Signature
p~ (~f:~
Title
Date
and CEO
MIAMI JEWISH HOME AND HOSPITAL
FO~:1ED ~
Signature
~Cf?)
~7 /UJb l-
. f
Title
Date
~ /Z$/~2.
I
Date
r-J
3: i.--::;)
C) c:::; ~
:z: ?~
::u 0 :::~:
g C.:-=,;;
--
O' r--
O~.
~?JS: .t:>>-
o' ::r:
::<~::r.
. p -
...,,;~ ...
T~ I i'Ti c:::>
MONROE cduNy ~<:CrL SfRVlCE~
YI
;
'. " 'J!...... . -,.
M~nro6 County Joara af C()unty~
Tltle Commissio ers Mayor
""T1
..,.,
co
,
U1
..,.,
r
rT'\
CJ
..,.,
C>
::;;0
Title
:::n
rr1
(J
CJ
A)
CJ
Signa!Jlfe
Date
_~ ojl (~/Of)..
I I
Page 10 of 10
APS Referral Prioritization
Local Protocols
Attachment I
Between
Department of Children and Families, Alliance for Aging,
United Home Care Services, Douglas Gardens Community Care,
First Quality Home Care and Monroe County Social Services
I. High Risk Referrals
A. Department of Children and Families, Adult Protective Services (APS) will fax the
referral to the Alliance for Aging Elder Helpline in Miami-Dade County and to
Monroe County Social Services (MCSS) in Monroe County.
1. Items to be faxed are the 1099 form, the risk assessment and the "Capacity
to Consent" form.
2. On the weekends, and eveningsAPS will call the Elder Helpline on-call
beeper number for Miami-Dade referrals or the MCSS Elder Helpline
phone number for Monroe referrals.
3. Fax will follow on the next workday.
4. For Miami-Dade County, during regular working hours, the Elder Helpline
first check CIR TS to see if the client is already being served by a Lead
Agency. If this is the case, the Elder Helpline will immediately notifY APS
who is serving the client. If a Lead Agency is not currently serving the
client, the Elder Helpline will immediately call and fax the Lead Agency the
referral. The Lead Agency is selected on a rotation basis.
5. For Miami-Dade County, after hours referrals, the Elder Helpline will
immediately make the referral to the lead agency on the rotation schedule.
On the next business day, the Elder Helpline will check CIRTS to
determine whether: (1) the customer is being served by a lead agency and
(2) whether the lead agency providing the services is also the same that
received the after hours referral. If the lead agency providing services
differs from the after hours lead agency that received the referral, then the
after hours lead agency must cease providing services. It is the
responsibility of the Elder Helpline to notifY the after hours lead agency to
terminate services. It is also the Elder Helpline's responsiblity to inform
the lead agency, APS and the Alliance for Aging Contract Management
who will be serving the consumer.
Page 1 of 4
B. The CCE Lead Agency will call the APS worker if they have any problems
contacting the consumer or in providing services to the consumer within 72 hours.
C. For Miami-Dade County:
1. The Lead Agency will visit and assess the consumer( s).
2. The Lead Agency and APS will conduct an initial staffing via the telephone
at the agreed time.
3. The Lead Agency and APS will staff all referrals received from Friday to
the following Thursday on Fridays.
4. The Lead Agency and APS will reach an agreement on the care plan.
5. Additional staffings will be done on a case-by-case basis until the situation
is stabilized.
D. For Monroe County:
1. MCSS will visit and assess the consumers.
2. MCSS and APS will staff the referrals received within the week in which
they were received.
E. A comprehensive assessment will be completed on all High Risk referrals within
two weeks from the date of referral.
F. The CCE provider will fax the second page of the 1099 to APS to confirm the case
has been received and the consumer is being served.
G. When it is mutually agreed that services from the Lead Agency are no longer
appropriate, necessary or are beyond the required 30 days, but the case may
remain open with DCF, the Lead Agency will report the situation at the regularly
weekly staffings. Upon agreement, the initiating party for closure will complete
the closing summary of page 3 on the 1099 form, sign, date and fax to the
recelVmg agency.
II. Moderate and Low Risk Referrals
A. Moderate and Low Risk referrals may be waitlisted in which case the Elder
Helpline will return via fax the 1099 to APS as notification.
B. If the status changes and becomes a High Risk Referral, APS will resend the 1099
and regular procedures will be implemented.
Page 2 of 4
III. Data Integrity
A. Alliance for Aging Contract Management will run the APS Exception Report by
the Itt' of each month. This report will be sorted by provider and distributed to
the appropriate Lead Agency.
B. Each Lead Agency makes the necessary corrections in CIRTS and notifies
Contract Management what cannot be resolved by the Lead Agency.
C. Contract Management will address the remaining discrepancies with APS.
D. Contract Management will report results to the Department of Elder Affairs on a
monthly basis.
IV. Safeguarding Information
Providers and Alliance agree to comply with paragraph I.R. of their respective Master
Agreements regarding Safeguarding Information, restated below:
Except as provided for department/Alliance auditing and
monitoring purposes, not to use or disclose any information
concerning a consumer who receives services under contracts
incorporating this agreement by reference or subsequent contracts
for any purpose not in conformity with state and federal regulations
(45 CFR, Part 205.50), except upon written consent of the
consumer, or the consumer's authorized representative.
I have read and concur with the above procedures. Any questions my agency has regarding the
agreement or its implementation will be addressed to the Alliance for Aging for clarification
and/or resolution.
)1\v.{Y)
Name
lL4 ; S bl f"
DEPARTMENT OF CHILDREN
AND FAMILIES
~LJ ____
Name2)~ -II ~
Ch~ ;t(. A"'fS Jt!Vtu,.-'
Signature
7 J{(,/Gl--
Date
ALLIANCE FOR AGING, INC.
J~- LU~
Signature
~\ ~1 ~~
Date
Page 3 of 4
t /..? I/pz..
.
DOUGLAS GARDENS
C~MMUNITY C~
.!) IPN (e:.- .DKLB;
Name~ 7)
Signature
'~7/UJCI t-
o I
Date
UNITED HOME CARE SERVICES, INC.
Jose R. Fox
Signature
Date
FIRST QUALITY HOME CARE
'Up/F.! gel~
MONROECOUNTYSOC~L
SERVICES
Signatur
t:~7hz-
Date / /
Charles ~eCo1~ BOCC
Name (.1 / /f
" / //
",,-.,t-..f" ,,/
/ l .,/'
Sign~ture/"":1'
/
J
/0 (Jr.., / D.::)..
/, /
Mayor
Date
BY
~ A NEA~N
Df\TE ~ r)"-'
Page 4 of 4