Michael Koenig, President Lori Smetanka, Interim Executive Director

Ph: 202.332.2275

Fax: 866.230.9789 www.theconsumervoice.org

The National Consumer Voice for Quality Long-Term Care (formerly NCCNHR) is a 501(c)(3) nonprofit membership organization founded in 1975 by Elma L. Holder that advocates for quality care and quality of life for consumers in all long-term-care settings.

1001 Connecticut Avenue, NW • Suite 425 • Washington, DC 20036

November11,2015KathyGreenlee,AdministratorandAssistantSecretaryAdministrationforCommunityLivingAdministrationonAgingU.S.DepartmentofHealthandHumanServicesWashington,DC20201

RE:CommentsonDraftConsensusGuidelinesforStateAdultProtectiveServicesSystems

DearAdministratorGreenlee:TheNationalConsumerVoiceforQualityLong-TermCare(ConsumerVoice)thanksyoufortheopportunitytoprovidecommentsontheDraftConsensusGuidelinesforStateAdultProtectiveServices(APS)Systems.TheConsumerVoicefullysupportsthedevelopmentoftheseguidelines,aswellasACLbeingtheFederalhomeoftheOfficeofElderJusticeandAPS.ConsideringtheintegralrelationshipoftheOfficeandAPSwithotherpartnersintheAgingNetworkmakesACLtheappropriateplaceforthemtobelocated.WealsoarepleasedattheeffortsexpendedtodevelopadatacollectionsystemforAPS,recognizingtheimportanceofdatainestablishinggoalsandprioritiesfortheAPSprogram.Asacomparison,theNationalOmbudsmanReportingSystemhasbeenaninvaluabletoolatboththestateandnationallevelsinidentifyingtrends,settingpriorities,andmanagingombudsmanprogramactivities.WebelieveanAPSdatasystemwillbeequallyuseful,pluswillprovideinformationtobeginfillinginthegapsthatcurrentlyexistrelatedtothetypeandprevalenceofelderabuse.1.ProgramAdministration:WesupportthedevelopmentofaCodeofEthicsforAPSPractice,aswebelieveitwillprovidefoundationalguidanceforresponseinchallengingsituations;andagreethatthekeyconceptsofLeastRestrictiveAlternative,Person-centeredservice,Trauma-informedapproach,andSupporteddecision-makingbeincorporatedintotheethicalprinciples.WedoincorporateherethesuggestionbytheNationalAssociationofStateLTCOmbudsmanPrograms(NASOP)tore-definePerson-centeredserviceandrecommendthatyouincorporatetheirreviseddefinitionintotheGuidelines.

ConsumerVoicerecommendsthattheGuidelinesclarifythatallvulnerableadultsbeeligiblerecipientsofservicesfromAPS,regardlessofwhethertheyliveinaninstitutionalsettingorinacommunitybasedsetting.Therecurrentlyislackofclarity,aswellaswideinconsistency,withinandamongstates,astothepopulationtobeservedbyAPS.ConsumerVoicethinksitisimportantthatAPSrecognizethatombudsmanarenotmandatoryreportersandaresubjecttostrictconfidentialityrequirementsestablishedinfederallawandregulation.Assuch,werecommendthattheGuidelineread,“…Exemptionstomandatoryreportingrequirementsshouldbeconsistentwithprofessionalethicalprinciples,aswellasestablishedlawsandregulations.”WewouldalsoencouragethedevelopmentofMemorandaofUnderstandingbetweenAPSandLTCOPsinordertofurthercollaborativeworkonbehalfofeldervictims.WesupporttheinclusionofAPSinbothformalandinformalcollaborations,includingmulti-disciplinaryteams.ConsumerVoicesupportsAPSaccesstoadequatelegalcounselforsupport,technicalassistance,andadvice.ConsumerVoicerecommendsthatAPSworkershaveaccesstoexpertspecialistsasneededtosupportaninvestigationorassistwithaclient.Examplesofexpertswouldinclude,butnotbelimitedto,financial,legal,mentalhealth,forensic,medical,dementia,substanceabuse,andsocialwork.2.TimeFrames:Consistentguidelinesforresponsetoanallegationofabuse,orreferraltoanappropriateentityoragencyareencouraged.3.ReceivingReportsofMaltreatmentConsumerVoicesupportstherecommendationthatAPShaveasystemforreceivingreportsofmaltreatment24hoursaday.WebelievethatAPShasaroleininvestigationofmaltreatmentincongregatesettings,andunderstandthatsufficientresourceswouldneedtobeallocatedtosupportthisrole.Residentsoflong-termcarefacilitiescontinuetobevulnerableandvictimsofabuse,neglect,andexploitation,andthusshouldbeaffordedtheprotectionsandservicesavailabletovulnerableeldersinthecommunity.5.ServicePlanningandIntervention

ConsumerVoicerecommendsthatuponclosingacaseinvestigation,APScommunicatewiththeindividualwhofiledtheallegationofabusewiththedispositionofthecase.Withoutthiscommunication,individualsfilingcomplaintshavenoideaifAPSrespondedorfollowedupinanyway.Wehaveheardfromseveralaboutfrustrationswithnotgettinganysortofresponse.6.TrainingConsumerVoicesupportsthedevelopmentofcorecompetenciesforAPSworkers,includinginitialandon-goingtraining,includingin-the-fieldtrainingandsupervision.Wealsobelievethattrainingstandardsshouldbeconsistentacrossstates.ConsumerVoicealsosupportsthecommentssubmittedontheAPSGuidelinesbyNASOPandtheMarylandStateLong-TermCareOmbudsmanProgram.Wecommendyou,AdministratorGreenlee,onyourleadershipinraisingthevisibilityofelderabuseandtheneedforincreasedsupportofElderJusticeprograms,includingAdultProtectiveServices.Pleasedon’thesitatetoreachoutifwecanassistinanyway.Sincerely,

LoriSmetanka RobynGrantInterimExecutiveDirector Director,PublicPolicy&Advocacy