Objective

To determine whether the Office of Children and Family Services (OCFS) is ensuring that Adult Protective Services (APS) providers have sufficient staffing and case management practices to implement APS requirements and protect vulnerable adults. The audit covered New York City APS referrals and open cases from April 2019 through August 2023 and casework and staffing information from April 2019 through October 2024.

About the Program

OCFS' mission is to serve New York’s public by promoting the safety, permanency, and well-being of our children, families, and communities. Toward that end, OCFS oversees APS, a program of State-mandated services for adults (age 18 and older) who, because of mental or physical impairments, are unable to meet their essential needs (e.g., food, shelter, clothing, medical care, securing entitlements); are in need of protection from abuse, neglect, financial exploitation, or other harm; and have no one who is willing and able to assist them responsibly. APS clients include vulnerable older adults and mentally ill, developmentally disabled, and abused or exploited people. According to research published in 2020,¹ every year about one in 10 older adults (age ≥ 60 years) in the United States experiences elder abuse, including physical, sexual, or psychological abuse, as well as financial exploitation or neglect by caregivers. Elder abuse also often goes undetected; only one in 24 cases are identified and reported to the proper authorities. Services provided by APS include investigating and assessing the referred adult’s needs and risk of harm, helping adults facing eviction, coordinating with law enforcement and other service providers (e.g., health, mental health, housing, homemaking), and assistance in obtaining benefits, ranging from informal financial management and court petitions to appointing a guardian or other legal intervention. OCFS is responsible for monitoring and coordinating APS programs statewide, which are administered locally by Local Districts of Social Services (LDSSs). OCFS provides technical assistance and conducts periodic APS practice reviews (Practice Reviews) to monitor compliance with State standards and coordinates, develops, and implements training for APS staff. Once a Practice Review is complete, OCFS may require the APS provider to submit a written Performance Improvement Plan (PIP) if the provider fails to be at least 85% compliant with APS requirements. In New York City, APS is administered by the New York City Human Resources Administration (HRA) through its Central Intake Unit (Intake Unit) and a network of 11 APS providers that, at the time of our audit, consisted of seven field offices and four contract offices. HRA is considered the LDSS of New York City, including all five boroughs, and is the largest municipal APS program in the country.

Key Findings

OCFS needs to improve efforts to monitor and assist APS providers, especially during periods of high turnover and staffing shortages, to ensure the needs of clients are fully met and that caseworkers maintain sufficient documentation of casework conducted. We identified deficiencies with documentation maintained on APS cases and in some instances with how APS cases were handled by caseworkers. Specifically:

• We identified a total of 100 deficiencies across 87 referrals for 52 clients, including visits not being conducted within the required time frame, eligibility determinations and service plans not completed in a timely manner, and missing documentation. The deficiencies we identified are likely attributed to staffing shortages and turnover resulting in inexperienced and potentially overworked caseworkers.
• OCFS does not routinely track and monitor APS providers’ staffing levels and—when it does become aware of issues with vacancies and turnover—it does not provide increased monitoring to follow up on the issues or offer additional assistance based on vacancies or turnover rate. Caseworkers struggling with high caseloads may have limited time to thoroughly assess each case, which could result in incomplete assessments or delayed responses to urgent client needs.
• We found, according to HRA officials and contractors, caseloads per caseworker varied significantly among APS providers, ranging from 25 to 90. Moreover, OCFS has not developed guidance or best practices on caseload management to assist providers.
• Although we found staffing and caseload issues to be a significant threat to APS providers’ ability to sufficiently serve clients, OCFS’ Practice Reviews did not include actions, such as requiring providers to develop a PIP to address case management or staffing shortages, as required.
• While less prevalent, but with a greater impact on services, we identified seven cases in which the caseworker may not have fully addressed the client’s needs, including:
  • A referral was made by a hospital social worker alleging self-neglect, unclean home conditions, and potential hoarding. This client was facing eviction because of these conditions. The progress notes indicated that, while the client could afford to hire a cleaner, she was unable to find someone willing to clean her home. The caseworker closed the case, citing “sufficient mental and physical capacity.” Two days after the case was closed, a second referral was made by a doctor for the same client. The second referral was handled by a different caseworker, who ensured that the home received a thorough cleaning. This second caseworker also identified an additional need and made a referral for a home health aide. It is possible that more could have been done for the client when the first referral was made. Had a second referral not been made, the client may have faced eviction and would not have received a referral for the necessary home health services.
  • A referral was received from a family member alleging mental illness, drug and alcohol abuse, and self-neglect. An initial visit was not attempted because the client was in the hospital; however, the caseworker’s notes stated that the client was discharged 2 days later, then readmitted after another 3 days had passed (this information was based on a conversation with the referral source 6 days after the referral was received). After that conversation, there were no case notes for over 3 weeks. After almost another 4 weeks had passed, the caseworker contacted the referral source who stated they were concerned for the client because the client was having suicidal thoughts and using drugs. The caseworker then initiated a 911 wellness check immediately after speaking with the referral source, but the first home visit was not attempted for another 24 days and there were no case notes between the 911 wellness check and home visit. The caseworker learned from a third party that the client had been hospitalized 8 days prior to the unsuccessful home visit attempt. Four days later, the case was closed under the category “someone else willing and able responsibly.” However, there are no case notes indicating that the caseworker discussed closing the case with a supervisor, which is required by HRA policy in cases like this. Without this information, there is little assurance that the case was properly closed.

Key Recommendations

• Develop a process to monitor vacancies and turnover at APS providers to determine if compensating efforts, such as conducting more frequent Practice Reviews or additional training and technical assistance, are necessary to improve case management.
• Develop basic standards or guidance for caseloads that are flexible and adaptable based on the unique needs of each LDSS, including conducting periodic studies to evaluate manageable caseload ratios and determine effective case management practices.
• Improve oversight of LDSS staffing and case management practices, including, but not limited to, assessing and noting deficiencies for staffing and case management practices during OCFS Practice Reviews and issuing PIPs as necessary to address deficiencies.

1 https://www.ajgponline.org/article/S1064-7481(20)30346-8/fulltext