RD357 - Report on the Feasibility of Transferring Adult Programs from the Virginia Department of Social Services to the Virginia Department for the Aging


Executive Summary:
Item 278 (E) of 2007 Appropriations Act requires a study to be conducted by the Secretary of Health and Human Resources on the feasibility of transferring Adult Services/Adult Protective Services (APS) and Adult Licensing from the Virginia Department of Social Services (VDSS) to the Virginia Department for the Aging (VDA). The study was to be done in cooperation with VDSS and VDA.

To carry out the study, VDSS and VDA established a workgroup comprised of agency representatives, local service delivery agencies and affected organizations. The workgroup began by examining how other states organize and deliver adult services and adult licensing. VDA provided an overview of the services they currently provide and of the services provided through Area Agencies on Aging (AAA). VDSS did the same for their Licensing and Adult Services/APS divisions. The overviews included organizational structures, summaries of staff responsibilities, funding sources, programs, and information systems. This exercise was useful for ensuring a common understanding of each agency’s role, duties, and services. Two subgroups were then established to examine Adult Licensing and Adult Services/APS programs individually.

The workgroup concluded that transferring Adult Licensing from VDSS to VDA is not feasible without addressing a number of critical factors. These factors include the agencies’ statutory and regulatory frameworks, staffing levels, office space and locations, and funding requirements and availability. The workgroup identified, at a minimum, the following needs:

• Office space for 57 staff members (spread among the state office and four field offices);
• Additional inspectors dedicated to adult licensing because some VDSS inspectors currently perform both adult and child facility licensing inspections;
• A new licensing information system implemented at VDA;
• Four new field offices; and
• Additional state vehicles for the added adult licensing inspectors.

The workgroup also concluded that transferring Adult Services/APS from VDSS to VDA is not feasible without addressing a similar set of critical factors. These factors include statutory and regulatory frameworks, client population, training requirements, program oversight, funding requirements, funding considerations and transfer at the local level. Some of the specific issues that must be addressed include:

• Adult Services/APS are mandated to serve incapacitated adults over the age of 18, whereas local AAA’s are mandated to serve adults age 60 and over.
• VDSS currently operates a joint Child Protective Services and APS hotline. Additional staff may be needed at VDA to perform tasks currently performed by VDSS.
• Transferring the Auxiliary Grant may jeopardize federal Medicaid funding for Virginia.
• The information system for Adult Services/APS will have to be transferred, technical infrastructure will have to be purchased, and system administrators will have to be hired.
• Social Services Block Grant funds will have to be reauthorized and transferred to VDA.
• Transferring responsibility and services at the local level is complex because of the locally administered structure of the state’s social services system.

The workgroup examined a host of related issues, including oversight and promulgation of regulations and necessary changes to the Code of Virginia. VDSS has a citizen policy board, the State Board of Social Services, which promulgates regulations for Adult Services/APS and Licensing. VDA operates with a single advisory board, the Guardianship Board, and the Commissioner has the authority to promulgate agency regulations. Transferring Adult Services/APS and Licensing to VDA may necessitate the creation of a policy board for that agency. For a transfer of Adult Services/APS and Licensing to occur, there would have to be changes to more than fifty sections the Code of Virginia. Some of the changes are as simple as transferring specific sections to Chapter 7 of Title 2.2, which applies to VDA. Many other laws that specifically pertain to licensing, however, would have to be amended and recodified for both VDSS and VDA because they contain common language that pertains to both adult and child services licensing. The workgroup suggested, in fact, that if a transfer of responsibilities were to occur, VDA might be better served by placing its statutes in a new Code title because of the significant number of added sections that would be required.

Although the workgroup concluded that the transfer of Adult Licensing and Adult Services/APS is not feasible, members offered a number of suggestions for improving the current system and several issues for further consideration. For example, VDSS Adult Licensing will be establishing an internal committee to develop a new weighted scoring system for inspections that takes into consideration risk values. The group will also address the following:

• Ensuring that inspectors use current forms;
• Improving the website to show a consistent level of detail on inspection reports;
• Developing a uniform tool to be used by all inspectors that is accompanied by detailed guidance documents;
• Involving stakeholders earlier in the process of developing regulations;
• Strengthening central office oversight to facilitate consistent regulatory decision-making; and
• Supporting person-centered programs within assisted living policies and regulations.

The following suggestions were offered to improve the service delivery of Adult Services/APS within the current structure:

• Amend the VDA and VDSS strategic plans to add goals, strategies and measures for increased coordination between the two agencies to improve the Commonwealth’s longterm care system.
• Establish regularly-scheduled joint meetings to include VDSS, VDA, LDSS, AAA, Community Services Board, public health and Centers for Independent Living professionals, and others to review best practices and adopt the best model for their local needs.
• Amend the Code of Virginia so that qualified AAA case managers can perform long-term care assessments.
• Encourage additional general funds for Home Delivered Meals (Meals on Wheels) and transportation to expand service to persons under the age of 60.
• Continue support of a No Wrong Door approach to providing long-term care services via a single point of entry.

Lastly, there was also general agreement among workgroup members that the collaborative dialogue that commenced with this study should continue. The group recognized that broader, long-term improvements will require input from agencies and organizations not represented on the current group, including the Departments of Medical Assistance Services; Mental Health, Mental Retardation and Substance Abuse Services; Health; Rehabilitative Services; and consumers.