The purpose of the Social Services to Adults (SSTA) Program is to engage clients and their formal and informal resources while in the process of decreasing risk to the client and achieving successful client goals through identification, linkage and enhancement of client supports and resources. This includes: Achieving or maintaining the client’s safe living environment in the community with formal and informal supports; Achieving or maintaining self-sufficiency; Preventing or avoiding abuse, neglect, self-neglect, or exploitation; Preventing or reducing unnecessary or inappropriate institutionalization; Achieving or maintaining economic self-support; and Securing necessary and appropriate institutional care services. The program seeks to build, sustain, and augment, rather than to replace, the adult's formal or informal resources. SSTA targets service delivery resources to those clients most in need. In this chapter, the following terms have the meanings indicated. Terms Defined. “Abuse” means the sustaining of any physical injury by a vulnerable adult as a result of cruel or inhumane treatment or as a result of a malicious act by any person. “Administration” means the Social Services Administration of the Department of Human Services. “Adult” means a person who is 18 years old or older who does not have a minor child living with and dependent on the person. “Adult Foster Care” means a program that provides a family setting in the community for an aged adult or an adult with disabilities who requires: Protective oversight; Assistance with the activities of daily living; and Room and board. “Adult's representative” means a person authorized by the adult to act on the adult's behalf, or the adult's court-appointed guardian. “Aged adult” means an adult who is 65 years old or older and that adult's spouse. “Case management” means services provided to an adult which include: A comprehensive assessment of the adult's strengths, needs, risk level, and resources; Development of a comprehensive service plan designed to address the adult's risk level and need; Referral to and linkage with appropriate resources both within the local department and in the broader community; Provision of direct services to the adult, if called for in the service plan; Advocacy with and on behalf of the adult to obtain, access, and secure available resources and to develop additional resources when necessary; and Monitoring and evaluation of the effectiveness and efficiency of formal and informal resources used in meeting the adult's needs and ongoing assessment of whether a need for continuing services exists. “Certified Adult Residential Environment (CARE) Home” means a certified adult residential protective living environment home that provides case management services to adults with disabilities 18 years old or older, who cannot live alone primarily due to mental or physical health impairments and need assistance with activities of daily living. “Client” means an adult who is eligible for and is receiving services from the SSTA program. “Crisis intervention” means case management on an intensive basis with the goal of restabilizing the adult's life situation. “Exploitation” means any action which involves the misuse of a vulnerable adult's funds, property, or person. “Formal Resources” means professionals and/or agencies that provide services or treatment to the client. “Home Delivered Meal Service” means the preparation and delivery of meals to the homes of eligible persons to prevent institutionalization, malnutrition, and feelings of isolation. This may include personnel, equipment, supplies, and food costs. “Informal Resources” includes but is not limited to family members, neighbors, volunteers, faith-based groups and other community members who are involved with the client as a support. “Information and referral” means the brief process which includes: Receipt of an inquiry about or request for information or service; Provision of information; or Identification of and referral to an appropriate available resource, including providing instructions regarding the application and eligibility requirements of the resource. “In-Home Aide Services” means services provided to an adult with a functional disability in need of assistance with activities of daily living. “Liquid assets” means any real or personal property, possession, or valuable the adult owns individually or jointly, which can be converted to cash for support and maintenance. “Local department” means the Department of Social Services or its designee in one of the 24 Maryland jurisdictions including Baltimore City and the Baltimore and Montgomery counties Departments of Health and Human Services. Neglect. “Neglect” means the willful deprivation of a vulnerable adult of adequate food, clothing, essential medical treatment or habilitative therapy, shelter, or supervision. “Neglect” does not include the providing of nonmedical remedial care and treatment for the healing of injury or disease, with the consent of the vulnerable adult, recognized by State law instead of medical treatment that the vulnerable adult receives voluntarily. “Non-aged adult” means an adult who is 18 years old, but not yet 65 years old or older. “Program” means the Social Services to Adults program. “Self-neglect” means the inability of a vulnerable adult to perform activities of daily living or to provide the vulnerable adult with the services: That are necessary for the vulnerable adult's physical and mental health; and The absence of which impairs or threatens the vulnerable adult's well-being. “Service plan” means the written plan developed with the adult or the adult's representative which describes the goal of service, the specific services to be provided, and the method for providing the services, and which includes at least the following: Lists of the adult's service needs as perceived by the adult or the adult's representatives as well as by the SSTA worker; An assessment of the adult's strengths, needs, risk level and resources as these affect service needs; A plan for meeting the adult's needs, including consideration of the roles to be played by: The adult; The adult's family; The adult's friends; Community resources; and Local department resources; Specification of the tasks to be carried out by: The adult; The adult's family or friends; Local department staff, including the SSTA worker; and Other agencies and resources; Specification of the service plan period during which the plan will be in effect; Specification of the expected frequency of contact between the SSTA worker and the adult; The schedule for redetermination of eligibility and reassessment of services; and At the time of reassessment, an evaluation of the appropriateness, the effectiveness, and the efficiency of service that have been received by the adult. “Vulnerable adult” means an adult who lacks the physical or mental capacity to provide for the adult's daily needs. An adult is eligible for SSTA if the adult: Is a resident of Maryland. Temporary absence from the State may not interrupt continuity of residence. Is in need of the services. Need is: Established if the local department determines that the program’s services will help the adult to achieve the program’s purposes; Determined by the local department staff based on information provided by the adult and other appropriate sources which may include, but need not be limited to: The adult’s family or friends; Medical or mental health providers familiar with the adult; or Resources to whom the adult is referred for assessment or evaluation purposes. Has income that does not exceed 80 percent of the State Median Income based on individual family size as described in COMAR 07.02.04.08 and has liquid assets as described within this regulation. The following criteria apply: Eligibility criteria for information and referral services or crisis intervention services is provided without regard to income; and Eligibility for on-going case management services may exceed 80 percent of the State Median Income should the adult be assessed as requiring In-Home Aide Services or Adult Foster Care, except as provided in §C of this regulation, if the adult is eligible for placement in a CARE Home. Has liquid assets that do not exceed: $19,999 for one individual; and $3,000 more for each additional family member. Liquid assets include, but are not limited to: Checking accounts; Savings accounts; Certificates of deposit; Stocks; Bonds; Life insurance cash value in excess of $3,500 per person; Real estate or property that is not the client's primary residence; Individual retirement accounts which can be drawn on without penalty; Trust fund accounts; Annuity accounts; Income from lottery prize winnings; and Mutual fund accounts. Agrees to receive the service and agrees to pay any fee assessed for services at the time of the initial application or during the reconsideration period. An adult is not eligible for SSTA if the adult, or the adult’s representative, does not agree to receive the services and/or participate fully in identifying and engaging needed resources. An adult is not eligible for SSTA while receiving case management from the CARE program or any other case management service program. The adult or the adult's representative shall make a referral for service to the local department in writing, by telephone, or in person. The local department based upon availability if staff, shall send a representative to take the application and establish the eligibility of an adult wishing to apply when the adult or the adult's representative is unable to come to the local department. The Department’s representative shall complete an initial assessment of the client’s risk, needs, resources, and eligibility within 10 days of receipt of referral. If the local department finds that it is faced with limited staff resources or experiences a delay in the completion of an application to establish eligibility, the client’s name shall be placed on a Client Waitlist without an assessment. After the adult is placed on the Client Waitlist without an assessment, the local department shall notify the adult or the adult’s representative in writing of the action. The written notice shall include the following: An explanation that, due to a lack of funding or staff, an assessment of the client’s eligibility for the program cannot be conducted by the Department at this time, and that the adult’s name will be placed on a Client Waitlist without an assessment; Information that explains that the adult will be contacted by the Department when staff is available to meet with them and discuss their eligibility and application for services; Information that directs the adult or the adult’s representative to contact the agency should the adult’s circumstances, need, risk level, or contact information changes so that their referral information can be updated; Information that specifies the regulation supporting the reason for any necessary intended agency action; and Information informing the adult that the local department shall contact the adult at least annually to ensure continued accuracy of the referral information, and that services are still needed. The adult or the adult's representative shall complete and sign an application, on a form provided by the Administration. When the request is for information and referral only, a signed application is not required. A request for information and referral service may be made in writing, by telephone, or in person by the adult or the adult's representative. The date of application is the date on which the local department receives the signed application. The local department shall collect the application and determine client’s eligibility and the type of service for which the applicant is appropriate. After determining eligibility and program appropriateness, the local department shall notify the adult or the adult’s representative in writing of the decision. If the decision is to: Accept the application for service the notice shall include the facts that: The adult is eligible for service and which service will be provided; Type and amount of service to be provided; and The right to, and the method for, obtaining a fair hearing; Place the client on a waitlist, the notice shall include the facts that: The adult is eligible for service, however, due to a lack of funding or staff, services are not available at this time and the client will be placed on a waitlist for services; Information directing the client or the client’s representative to contact the local department should the client’s need, risk level, or circumstances change; and The specific regulation supporting the reason; or Deny the application for service, and the notice shall include the: Reason for the denial; Specific regulation supporting the reason; and Right to and the method for, obtaining a fair hearing. Service Appropriateness. Information and Referral service is appropriate for an adult with generally adequate coping skills and who: Has a question about the existence or availability of a resource in the community; Requires a service not provided by the department but with minimum assistance can use another system providing the needed service; and Has a problem and is able to make independent decisions but refuses other services from the department. Crisis Intervention service is appropriate for an adult whose normal coping patterns have failed and who: Is experiencing a situational change; Needs guidance in taking on a new role or achieving other adjustment; and Has at least minimal capacity for independent functioning. Case Management service is appropriate for an adult who: Seeks to achieve or maintain economic self-support; Seeks to achieve or maintain self-sufficiency; Seeks assistance navigating needed service systems; Is at risk of abuse, neglect, exploitation, or self-neglect; Requires service from the local department or other resource in order to be discharged from an institution; Is discharged or released from a nursing institution has sufficient capacity for independent living and decision-making but requires service from the local department or other agency in order to secure appropriate resources to live in the community; Is experiencing a crisis, examples of which include but are not limited to adults in the following circumstances: Previously a recipient of community service, but no longer eligible; Recently unemployed; Homeless; or Recent loss of a spouse; Seeks to engage and enhance involvement with formal and informal resources; Seeks to achieve successful personal outcomes; or Requires In-Home Aide Services, Adult Foster Care, or who is eligible and waiting for placement in a CARE home. Information and Referral. When only information and referral is needed, the local department, no later than 5 working days following the request for service, shall: Clarify the type of information or referral which is requested, if needed; and Provide information, about availability of programs, appropriate to the request, or make a referral to an available resource, including direction regarding the application and eligibility requirement of the available resource. When providing Information and Referral Services, the SSTA worker shall have contact with the adult or the adult’s representative as needed in order to: Assist the client in identifying, engaging and/or enhancing the client’s access and involvement with available formal or informal resources; and Identify and inform the local department administration staff of unmet needs or barriers to service delivery. The local department may not deliver information and referral service for more than 30 days after the date of application. Crisis Intervention. When crisis intervention is appropriate the local department shall: Begin a full assessment of the adult’s eligibility, needs, strengths, and resources by no later than the first work day following the date of application; and Establish a service plan by no later than 14 calendar days following the date of application. During crisis intervention services, the SSTA worker shall have face-to-face contact with the adult on at least a weekly basis in order to: Provide counseling and other services which the worker has agreed to provide as part of the service plan; Assist the client in accessing to available resources as required by the service plan; Monitor the effectiveness of any service to which the adult is referred or which is serving the adult; Monitor progress in achieving the goals of the service plan; Revise the service plan as needed; and Identify and inform the local department administrative staff of unmet needs or barriers to service delivery. The local department may not deliver crisis intervention service for more than 60 days after the date of application. Continuing SSTA Case Management Services. When case management is appropriate, the local department shall: Begin a full assessment of the adult’s eligibility, risk level, needs, strengths, and resources by no later than 7 calendar days following the date of application. In the event that there is an indication that the adult may be institutionalized if service is not provided, the assessment shall begin no later than the first working day following the date of application. Conduct an analysis of the case no more than 90 days after acceptance of the case at Intake. This analysis is to determine whether the case will be open in Continuing Social Services to Adults, closed or assigned to the waitlist. This analysis should focus on the client’s level of risk, level of dependency on the local department, and the resources needed to support the client’s goals as stated in the Service Plan. Conduct a case analysis at the time of case reconsideration to determine whether case will be closed or whether staff resources will be committed to the case up to an additional 6 months. Conduct a case analysis at any time there is a significant change in the client’s circumstances and/or risk. Establish an individual service plan by no later than 90 calendar days following the date of application. During case management service, the case manager shall have contact with the adult monthly through face-to-face contact no less frequently than once every 3 months in order to: Provide services which the worker has agreed to provide as part of the service plan; Assist the client in identifying, obtaining and/or enhancing access and involvement with available resources as required by the service plan; Monitor the effectiveness of any service to which the client is referred or which is serving the client; Monitor progress in achieving the goals of the service plan; Revise the service plan as needed but not less than every 6 months; and Identify and inform the local department administration staff of unmet needs or barriers to service delivery. Adult Protective Services. While providing the service of this program, the SSTA case manager shall be alert for indicators of abuse, neglect, exploitation, or self-neglect and, therefore, requires Adult Protective Services. If the SSTA case manager determines that indicators of abuse, neglect, or exploitation exist, the worker shall make a referral to Adult Protective Services immediately. If the SSTA case manager determines that indicators of self-neglect exist, the worker shall make a referral to Adult Protective Services if: The adult or the adult's representative does not agree to and cooperate with a SSTA service plan which would result in a substantial abatement of the risk due to self-neglect; or Guardianship of the Person of the adult is necessary to mitigate the risk due to self-neglect. When the SSTA case manager refers a SSTA client to Adult Protective Services, the case manager shall continue services to the client until Continuing Adult Protective Services has begun. In-Home Aide Services. When the service plan indicates that an adult needs service from the In-Home Aide Services program, the case manager shall complete a written referral to the In-Home Aide Services program. The referral shall include at least the following: A clear list of the specific aide services requested; An explanation of why aide service is needed and what other resources have been explored to meet the adult's need for aide service; and A statement of the specific objectives to be achieved by the aide service. When the SSTA case manager reassesses the client’s service plan which includes use of In-Home Aide Services, the worker shall: Request from the In-Home Aide Services program staff a Progress Report outlining their evaluation of the effect and effectiveness of the aide service on the client's overall circumstances; and Notify the In-Home Aide Services program of any changes to the contents of the referral. When the case manager determines that the adult requires immediate service from the In-Home Aide Services program in order to prevent abuse, neglect, self-neglect, exploitation, or institutional placement, the worker shall make an immediate verbal request to the In-Home Aide Services supervisor. The SSTA worker shall forward a written referral to the In-Home Aide Services supervisor within 5 working days of the verbal request for services. When the case manager is notified that service to an adult from the In-Home Aide Services program will be or has been terminated, the worker shall begin a reassessment of the adult's service needs immediately, unless the termination is the result of a service plan previously developed by the worker with the adult or the adult's representative. The local department shall make a redetermination of eligibility: When required on the basis of information the agency has obtained about change or anticipated changes in the adult's situation; Promptly, not to exceed 30 days, after information is obtained by the local department about changes in the adult's circumstances which may make the adult ineligible; or Periodically, but not less frequently than every 6 months. The local department shall make a reassessment of service needs: Whenever required because of a significant change in the adult's circumstances which may affect the type or amount of service the adult needs; or Periodically, but not less frequently than every 6 months. A reassessment shall include, at least: A review of the most current service plan to determine progress towards goals; An assessment of the effectiveness and efficiency of the formal and informal resources which have provided support to the adult during the most recent service plan period and any previous period, if appropriate; A reassessment of the adult's strengths, needs, level of risk, dependency on the local department, and resources; and Development of an individualized service plan for the next service period, if the decision is that services are to continue; and Conduct a case analysis to determine whether the case will be closed or whether staff resources will be committed to the case for up to an additional 6 months, by focusing on the client’s level of risk, level of dependency on the local department and needed resources to support achievement of the client’s goals as stated in the client’s service plan. Whenever the local department does a redetermination of eligibility, the local department shall also: Complete a reassessment; and Notify the client or the client’s representative in writing of their eligibility status for services. The local department shall terminate the provision of SSTA when: The adult is no longer eligible; An eligible adult moves to the jurisdiction of another local department and a referral for service to that department is made; The adult is in need of Continuing Adult Protective Services and referral to that program is made and service has begun; Specific, measurable, time-limited goals and objectives have been reached; The case manager determines the adult no longer needs the service, or level of service currently provided; The case manager determines the service has not been effective in achieving the specific goals, objectives, and changes in the client's condition which were expected to result from the service, and that continued service is not expected to be effective; The adult requests termination; The adult has died; The adult has entered a long-term care facility; The adult, the adult's family or other informal supporters have failed to perform the tasks specified in the service plan agreement; An adult on the waiting list declines to receive SSTA; An adult exhibits uncooperative behavior, abuse, or misuse of the service; or The adult or the adult's representative refuses to accept specific time-limited goals, objectives, and recommendations of the service plan. Whenever SSTA case management is terminated because the adult, or the adult's representative, does not agree to receive the service, the case manager shall assess and document whether a reason exists to report the case for an Adult Protective Services investigation. Client Waitlist without an Assessment. The local department shall establish and enforce a procedure for governing a written waiting list for customers requesting services, if due to a lack of staff the local department is unable to assess the client’s need and eligibility for services at the time of referral. Client Waitlist with an Assessment. The local department shall establish and enforce a procedure governing a written waiting list for adults, assessed and determined eligible for services, if the local department is unable to provide SSTA based on available resources or staffing or both. SSTA case management services staff shall be provided to applicants in accordance with the local department criteria. Eligible adults shall be ranked in accordance with the local department’s established criteria which shall take into account the adult’s vulnerability, level of risk, needs and available resources. The local department shall update the client’s ranking on the waitlist as necessary, based on reported changes in the customer’s status but not less frequently than every 6 months. Appeal of the Local Department Decision. The local department shall give written notification of the right to and the procedures for, requesting and obtaining a fair hearing to each applicant or recipient of public assistance at the time of application, and whenever the local department notifies the applicant or recipient of any action which might deny, delay, suspend, reduce, or terminate assistance. The procedures are set in COMAR 07.01.04. Discrimination. The local department may not discriminate in the delivery of services as required by the nondiscrimination regulations in COMAR 07.01.03. Human Services Article, §§4-205(a), 4-207, 5-205(a), and 5-207, Annotated Code of Maryland Effective date: November 4, 1977 (4:23 Md. R. 1729) Regulation .11 amended effective November 3, 1978 (5:22 Md. R. 1672); September 7, 1979 (6:18 Md. R. 1457); July 1, 1980 (7:13 Md. R. 1272); August 17, 1981 (8:16 Md. R. 1362) Regulations .01—.11 under Community Home Care Services repealed effective July 29, 1985 (12:15 Md. R. 1510) Regulations .01—.12 adopted effective July 29, 1985 (12:15 Md. R. 1510) Regulation .03A amended effective November 26, 1990 (17:23 Md. R. 2732) Regulation .12 amended effective October 6, 1986 (13:20 Md. R. 2209); July 12, 1987 (14:14 Md. R. 1570); July 1, 1988 (15:11 Md. R. 1330); July 1, 1989 (16:12 Md. R. 1333) Regulation .12 repealed effective November 26, 1990 (17:23 Md. R. 2732) Recodified from COMAR 07.02.15 to 07.06.13, December, 1992 Chapter revised effective October 29, 2001 (28:21 Md. R. 1854) Regulation .02B amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .03 amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .05 amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .06 amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .07 amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .08C amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .09 amended effective December 1, 2008 (35:24 Md. R. 2075) Regulation .11D amended effective December 1, 2008 (35:24 Md. R. 2075) Chapter recodified from COMAR 07.06.13 to COMAR 07.02.15, effective June, 2009 Regulation .01 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .02B amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .03 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .03A amended effective August 20, 2012 (39:16 Md. R. 1079) Regulation .03C amended effective April 18, 2011 (38:8 Md. R. 505) Regulation .04A—C amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .05 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .06 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .07 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .08 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .09 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .10 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .11 amended effective April 10, 2017 (44:7 Md. R. 353) Regulation .12 repealed effective April 18, 2011 (38:8 Md. R. 505)