1. Senate Health and Human Services Committee
Presentation on Senate HHS Charge 6 relating to guardianship programs
Senate Health and Human Services Committee
May 12, 2010
Beth Engelking, Assistant Commissioner
Adult Protective Services
I am glad to be here in my new role.
Before I begin, I would like to thank Commissioner Traylor and his staff for their hard work to implement the changes to the guardianship process with us.

2. Texas Department of Family and Protective Services
APS Mission
The mission of Adult Protective Services (APS) is to protect the elderly and adults with disabilities from abuse, neglect, and exploitation (ANE).
Slide 2 states the APS mission.

3. Texas Department of Family and Protective Services
In FY 2009, in the APS In-home program…
89,489 Reports of ANE
72,265 Investigations Completed
50,936 Investigations with at Least
one Allegation Validated
69,841 Validated Allegations (see pie chart)
453 referrals to DADS for Guardianship
Slide 3 provides FY 09 data
As you can see, only a small number of cases are appropriate for referral to DADS.
Definitions:
Reports of ANE: the total number of reports A/N/E and intake assigned.
Investigations Completed: Number of completed and approved APS investigations.
Investigations with at Least one Allegation Validated – all cases with a validated allegation.
Validated Allegations – All allegations that the investigator determined to be validated.
Referrals for Guardianship – This figure comes from DADS.

4. Texas Department of Family and Protective Services
History of the Guardianship Services Program in Texas
The State Guardianship Services program was established as part of the APS program in September 1993 to serve children aging out of foster care and began including APS clients in September 1995.
The State Guardianship program was transferred from APS to DADS during APS reform in December 2004.
The transfer of the guardianship program to DADS was codified in SB 6 effective 09/01/2005
A Memorandum of Understanding (MOU) was created in 2006 between DFPS and DADS outlining the roles and duties of each agency.
Slide 4 gives history of Guardianship program.

5. Texas Department of Family and Protective Services
APS Investigates Allegations of ANE
Chapter 48 of the Human Resources Code authorizes APS to investigate allegations of abuse, neglect, or exploitation (ANE) of elderly and adults with disabilities. As part of the investigation, APS:
Conducts a thorough assessment of client needs in every case using CARE tool
May obtain Emergency Orders for Protective Services (EOPS) if the client is in a state of abuse or neglect “that presents a threat to life or physical safety”
May obtain a professional assessment* of a client’s capacity “to consent to services” when:
An EOPS is needed,
A client at high risk (i.e., a threat to life or a serious imminent threat to physical safety) refuses services,
A client is in an ongoing state of ANE and may need a guardian
Once the investigation has been completed, APS develops a service plan to remedy the abuse, neglect or exploitation validated during the investigation, which may include a referral for guardianship services among other things.
*This assessment is not the same as a certified medical assessment required for guardianship under the Probate Code.
CARE=Client Assessment and Risk Evaluation
Procedures for Seeking Professional Assessments
For High Risk Clients, APS Specialist-
-consults with supervisor to determine need for Professional Assessment -examples of who conducts assessments: a physician, registered nurse, or physician assistant,
-obtains written statement of clients’ capacity and physical/mental condition to determine if EOPS is necessary, and
-may refer to DADS guardianship program.
(EOPS is good for 3 days and may be extended for 30 days)
For Medium Risk Clients, APS specialist-
consults the supervisor to determine need for a Professional Assessment,
arranges to have the client evaluated by a physician,
-obtains a verbal or written statement of the client’s capacity to consent, and

6. Texas Department of Family and Protective Services
APS Makes Referrals to Guardianship Programs
Before referring a client to a guardianship program, APS determines if:
The client is in an ongoing state of ANE and is at risk of ANE
Initial indications are that:
Least restrictive alternatives (LRAs) through family and friends or other social services are not adequate to protect the client
No suitable family or friends are willing to serve as an “alternate guardian”
The client has sufficient resources or benefits to meet his or her needs or will be eligible for resources or benefits
Guardianship may resolve some or all of the problems and protect the client
If APS considers a public guardian necessary, then:
The case is reviewed by the APS regional risk/exploitation specialist to ensure the case is appropriate for referral.
A referral is made to:
DADS guardianship services
County programs in Houston and Galveston Counties
Making a referral for guardianship is a very serious step.
We make every effort to pursue other remedies that will ensure client safety.
Regional SME’s, provided by SB6, have been designated as the experts in the policy and process of guardianship referrals.
Once a referral is made, DADS may find an LRA or alternate guardian
The CME may show the individual is not incapacitated
They may determine that guardianship may not resolve all of the problems – for example, one of the most difficult types of cases is adults with mental illness.
When DADS says no, we have appeals processes up to and involving the commissioners of our agencies.

7. Texas Department of Family and Protective Services
APS Assists in the Guardianship Process
If APS makes a referral to the DADS guardianship program, then:
The caseworker completes a detailed referral form that:
Outlines the client problems that a guardianship will address
Provides information on LRAs and alternative guardians explored
Provides other relevant case information for the guardianship assessment, including 6 month prior ANE history
The regional risk/exploitation specialist approves the referral
APS staff work in partnership with DADS guardianship staff to:
Assist in their assessment
Prepare information for filing with the probate court
Serve as a resource during the probate proceedings
APS continues to provide services as long as needed to ensure client protection.
Slide 7
Other relevant case info. (SEE ATTACHMENT - APS PROVISION OF RELEVANT CASE INFORMATION TO DADS FOR GUARDIANSHIP REFERRALS PER MOU AND POLICY)
MOU INCLUDES (p.5 and 6):
MINIMUM REFERRAL INFO APS INCLUDES IN REFERRAL TO DADS
INFORMATION CONCERNING ASSETS/INCOME/RESOURCES.
“HARD COPY” INFO – WITHIN 5 DAYS OF REFERRAL TO DADS
Policy –
The probate code requires that the application for guardianship include information that demonstrates the client’s lack of capacity during the 6 months preceding the guardianship application.  That is why we have directed staff to specifically address this area in the guardianship referral in order to strengthen the guardianship application if DADS decides to file for guardianship.  It also gives DADS more information about the client’s situation and what led up to the decision to refer the client for guardianship.

8. Texas Department of Family and Protective Services
Changes Resulting from HB 3112
(81st Texas Legislature)
DADS must file for guardianship in 70 days or request a one-time 30-day extension from APS.
The MOU was updated to address HB 3112 and also addresses other policy and process improvements.
Policies, procedures, and training have been implemented to reflect the changes outlined in the updated MOU.
Slide 8
Updating the MOU gave us the opportunity to discuss and resolve issues since the initial MOU in 2006.
It was a very productive process.
Senator Nelson was the Senate Sponsor of HB 3112

9. Texas Department of Family and Protective Services
Current Landscape
APS and DADS will continue to work together to protect clients that need guardianship services
Implementation of the recent MOU will improve the APS referral process
A direct electronic interface is being established for guardianship referrals to be sent from DFPS to DADS
APS and DADS will continue to use a cross-agency appeals process to handle difficult cases
Through the Interagency Steering Committee, APS will monitor implementation of HB 3112 (81 R) and the MOU
APS is the safety net for the safety net.
Issue is capacity in the system.
Slide 9
There will continue to be difficult APS cases that do not fit neatly into the social services delivery system in Texas.
- APS is the safety net for the safety net
Clients ineligible for DADS guardianship and where APS cannot resolve ANE are at risk of recidivism
Undocumented residents: no long-term funding source
Issues are capacity of the system combined with the projected growth in the elderly population.
Slides give examples of clients that APS refers to DADS.
-These are examples of actual cases.

10. Texas Department of Family and Protective Services
Addendum -
Typical Profiles of Clients Potentially Needing Guardians

11. Profile of an APS Guardianship Referral
Married couple in their 80s, both with dementia and multiple medical concerns. Incapable of managing medications. Evicted from multiple care settings due to non-payment because of exploitation by grandson. Daughter attempted to take over as power of attorney, but couple accused her of stealing, mismanaging funds, and she is no longer willing to be involved.
DADS files for temporary guardianship, then pursues permanent.

12. Profile of an APS Guardianship Referral
81 year-old female living alone. Appears to have dementia. Living conditions are deplorable, ceiling collapsing in half the home, windows broken out, trash everywhere and raccoons are in the home. Son has been estranged for years. Client refuses to leave the home.
Emergency Order of Protective Services (EOPS) to remove and place client, referred and accepted for DADS guardianship.

13. Profile of an APS Guardianship Referral
53 year-old female with mental disability. No family willing/able to obtain guardianship. She has been in and out of group home settings many times. “Boyfriend” finds her and takes her from placements. On “payday” he takes her check and will leave her alone for weeks at a time. He is sexually and physically abusive. When she does have cash she “banks” it in her P.O. box.
Placed in ICF/MR, referred and accepted for DADS Guardianship.