The State Office of Children and Family Services is not adequately overseeing adult protective service providers responsible for protecting vulnerable adults to ensure they are handling cases properly, putting at-risk New Yorkers potentially in harm’s way, according to an audit released today by State Comptroller Thomas P. DiNapoli.
“Every month thousands of vulnerable adults are referred to the state for help because they are being abused or unable to care for themselves,” DiNapoli said. “New Yorkers need assurance that the providers hired to help these men and women are doing just that. The agency responsible for protecting them must do a better job.”
Elder abuse is a problem nationwide, with 1 in 10 older adults subject to physical or psychological abuse, neglect or financial exploitation. Many cases are not reported. Every month OCFS receives an average of 2,500 referrals for help in New York City and 1,800 in the rest of the state. Referrals, which can come from anyone whether a family member, a neighbor or a bank employee, fell dramatically during the COVID-19 pandemic (March 2020–Dec. 2020) to an average of 1,500 referrals a month each from the city and areas outside of it.
OCFS provides Adult Protective Services (APS) for vulnerable adults, many of them senior citizens, who need help with food, shelter or medical care. APS providers receive referrals and are responsible for assessing each case to determine what help is needed, such as a new living arrangement, money management advice, meal deliveries or counseling.
The provider also decides if the situation is life-threatening, which requires investigation within 24 hours, or non-life threatening, which requires investigation within 72 hours. The most common referrals relate to mental illness, eviction or homelessness, inability to manage finances and inability to manage basic needs.
DiNapoli’s audit found lack of agency oversight and a failure to ensure providers are doing their job to protect at-risk adults. At a minimum, the state is supposed to review each provider every three to four years. But when auditors looked at a sample of 20 reviews, they found 13 (65%) were not done on time (they averaged 5.67 years) and one provider, which had been offering services in the city for seven years, had never been reviewed.
The agency’s reviews of service providers were also missing critical information. Of the 20 reviews sampled:
- 13 didn’t have the number of open referrals being assessed.
- 10 didn’t list how many referrals were withdrawn at intake.
- 6 didn’t include the number of referrals that were ongoing cases.
- 3 didn’t include how many referrals were closed at intake.
- 1 didn’t state how many referrals were received during the review period.
For three reviews, problems were found that called for follow up. Such problems included mislabeling how some cases should be handled, not entering progress notes as events occurred, and assessing case time management. The agency had no documentation to show whether a follow up took place and the problems were fixed and said it does not require providers submit documents to show deficiencies have been corrected.
DiNapoli’s auditors also looked at 61 referrals to 12 service providers to see if the at-risk adults received proper assessments and got the help they needed. The audit found providers generally started investigations and contacted clients on time.
However, at one provider on Staten Island, all five cases lacked sufficiently detailed progress notes to verify that actions taken for the client were appropriate. These notes are vital to track whether services are helping clients. For example, progress notes would state “Caseworker assessed the client” rather than provide details of the assessment or services provided.
DiNapoli’s audit made several recommendations to the agency, including that it work more closely with providers to improve documentation of case progress and assessments of clients’ needs.
While the agency agreed with some of the audit’s conclusions, it disagreed with a number of the findings, and concluded that concern over progress notes is “overstated.” The agency’s full response is included in the audit.
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