Most Critical

Adult Safety and Protection Team top recommendations
Following - not in priority order - are the ten recommendations that the Adult Safety and Protection Team believes are most critical for improving the safety and protection of individuals in licensed long-term care settings:

• A Statewide (preferred) or locally-based Call Center(s) should be established to handle the wide variety of calls now handled by the local APS Offices. The role and resources of the local APS Offices should be re-focused on the conduct of investigations. There should be an emphasis on maintaining strong relationships between central office and local offices and there should be a single statewide phone number. 211 should be researched as possible system to address the issue.
• The State shall develop or secure a competency-based training program with basic standards for investigations of abuse cases.
  
• The state should develop an abuse screening, prevention/early detection accessible training program utilizing a variety of modalities appropriate for the following audiences: employees, residents, and their families.
• Public Education, transparency, and accountability through processes such as: A) Central Office should periodically issue press releases on the more serious abuse and licensure cases that have been substantiated. Establishing a target of six - eight such releases over a calendar year is recommended. B) Central Office should consider issuing a brief annual report highlighting residential facilities/programs' rates and severity of substantiated abuse reports. This report should be issued with a press release to the local media. The report should highlight the BEST performers. The State may even want to issue some sort of award certificates. The release of these statistics publicly is likely to be a more effective "sanction" than those now used by the State.
• Improved relationship with law enforcement: The State should assure an established relationship in each county and point of contact and regular communication between local APS staff, the police/sheriff, and the DAs office, and others as appropriate.
  
• Improved relationship with law enforcement: The State should establish a phase-in goal for an adult Multi-Disciplinary Team in each county along the lines of the Clackamas protocol, and in small counties explore a combined child and adult MDT that can do both.
  
• The State should create a basic two week training course taught at DPSST to include interviewing, report writing, evidence collection, and sexual assault investigations.
• As of 1/1/2012 (or as soon as practicable once the training is established), local APS Offices shall assign (whenever possible) investigators who completed this program to investigate allegations of sexual abuse.
  
• The State should develop a registry of all substantiated abuse perpetrators and the severity of their abuse. It should be available on the State's web site and all providers should be required to check the registry prior to hiring. The recommendation is predicated on appropriate due process protections being in place.
  
• The time frame for the completion of abuse investigations by Local APS Offices should be shortened to 30 days (from 60 days) and Central Office should ensure effective monitoring and intervention of timeliness standards. [A benchmark of 90% timely would be a reasonable standard.] This process recommendation should be further explored recognizing that it is unrealistic with the current staffing levels. DHS should continue conversations with the legislature around funding for increased staffing levels. Additionally, the whole investigation and corrective action timeline should be looked at for efficiencies.

Prevention

1. If developing a statewide registry is not possible in the near future, DHS should continue its internal its use of a "substantiated abuse data base." The data base should be expanded to include all individuals with substantiated abuse, but the registry should also relate the severity level of the case.
2. Licensed long-term care providers should be required to ensure that all new and existing employees complete training within 90 days of its availability and/or as is consistent with licensing requirements. Appropriate standards for annual or bi-annual employee re-training should also be established.
3. The State should take steps to encourage a partnership between volunteer long-term care ombudsman in coordination with the facility and engage residents to help educate about resident safety and abuse prevention.
4. Long-term care residents and families should be offered the opportunity to take a training program prior to enrollment or within 30 days and annually.
5. The state should explore existing abuse training/awareness protocols for use with licensed facility staff, family members, consumers, and the public at large.
6. The State should revise its child abuse statutes to state that child abuse information can be used to protect seniors and people with physical disabilities in addition to children.

Intake

7. DHS shall receive immediate notice of all abuse allegations being investigated by local APS Offices and early intervention services shall be provided, as appropriate.
8. DHS shall develop written guidelines for the referral of cases coming to the Call Center and documentation requirements for "screened out" or "referred out" cases. Employees assigned to the Call Center shall be required to complete a competency-based training program regarding these guidelines.
9. DHS shall be responsible for periodically evaluating the appropriateness of "screened out" and "referred out" cases and preparing a public report (at least annually) of its findings, with recommendations as applicable. The initial study shall be completed on or before January 1, 2012.

Investigation

10. Local APS Offices should present more comprehensive and informative preliminary summaries accompanying their substantiations of facility wrongdoing.
11. DHS should conduct an overall review of its resource utilization for abuse investigations and oversight/reviews of local APS Offices with a goal of reserving significantly more resources for its immediate review of new abuse allegations, its direct conduct of the most serious investigations, and its immediate availability to assist local APS Offices in the conduct of investigations.
12. The State should further explore whether local APS Offices should make preliminary determinations of whether the investigations substantiated abuse in their investigation reports.
13. The preliminary summary of each APS report should cite Oregon Administrative Rules used to make determination.
14. Oregon should encourage qualified forensic investigations/exams for sexual abuse or physical assaults with the consent of the victim in accordance with established protocols for informed consent for medical treatment.
15. Local APS Offices should discontinue using the closing case determination, "incident occurred."

Systemic Corrective Action and Quality Improvement

16. DHS should regularly use its data base to develop mechanisms so it has a better understanding of filed allegations and substantiated abuse reports in an effort to keep vulnerable Oregonians safer. The following trend studies/reports should be considered over the coming year and whenever possible, link the data trends to DHS goals. These should be brief reports that, as applicable, could be released to the public, such as: A trend study examining the circumstances, nature, injuries, and outcomes of allegations of abuse investigated by local APS Offices in the past year (July 2010 - June 2011); A trend study examining the circumstances, nature, injuries, and outcomes of all substantiated abuse investigations in the calendar year 2011; Study outcomes and processes and the length between the two.
17. Based on the most critical outcomes identified for the APS system, DHS should develop the capacity internally to implement quality assurance reviews of APS work for both state and AAA local offices. For example: A critical review of calls deferred from local APS Offices investigation for a recent 30-day period (n = 1,250); and a critical review of the comparative abuse and wrongdoing substantiation rates across local APS Offices.

Other

18. Improved relationship with law enforcement: The State should develop training curriculum for annual training of MDTs.
19. DHS should develop a phase-in plan and budget proposal for across the board fingerprinting and a "rap-back system".
20. DHS should expand and modify as needed the Child Welfare Critical Incident Response Team (CIRT) policy and procedure to include serious injury or fatality resulting from abuse or neglect of a senior person with physical, mental, or developmental disability about whom the department previously received a report.
21. The State should eliminate expungement for criminal mistreatment of adults (like child abuse).
22. The State should expand ORS 443.004 (which precludes individuals with certain criminal convictions from employment in an SPD licensed site) to include skilled nursing facilities.
23. Mandatory reporters should have to report elder abuse also in their "unofficial" capacities.
24. The State should create another one week course for new sexual assault investigators.
25. Improved relationship with law enforcement: The State should explore a uniform format statewide to track APS referrals and results between APS offices and law enforcement.
26. The State should create a separate work group to explore better strategies for resident-to-resident abuse.
27. If the reported victim has a family member or healthcare representative, they should be notified at the discretion of the reported victim.
28. DHS should explore using OR-kids for APS along lines being considered by Washington State.
29. If the reported victim has a guardian, the APS investigator should notify them of the alleged abuse immediately and include this guardian in the investigation and outcome. The victim should also be notified of the outcome as appropriate. (A lawyer should review this recommendation).
30. The State should change Oregon law to allow restraining orders for victims in facilities.