Background and Objectives The Centers for Medicare and Medicaid Services (CMS) restricted long term care (LTC) facility visitation to only essential personnel during the COVID-19 pandemic. The Maryland Department of Human Services distributed Amazon Echoshow 8 voice and touchscreen controlled smart speakers (VTCSS) to a sample of their institutionalized guardianship clients to enhance caseworker access during the pandemic. Research Design and Methods This pilot study focused on understanding VTCSS use challenges and the effects on clients’ safety and well-being. Two focus groups were conducted with caseworkers (N=16) who piloted the devices. The interviews were recorded, transcribed, and analyzed using open and axial coding. Results Four themes were identified, including challenges to providing casework during the pandemic (e.g. facility technology gaps), challenges to device installation and use (e.g. privacy concerns), strategies for overcoming challenges (e.g. alert features), and benefits (e.g. stimulation, care monitoring) and uses (e.g. enhanced access, entertainment). Discussion and Implications VTCSS show great promise to engage the client, maintain visual access, and monitor quality of care. However, facilitating access to such technology requires planning and training before installation.

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This qualitative evaluation study was part of a larger Continuous Quality Improvement initiative implemented by the Maryland Department of Human Services Office of Adult Services to improve the Adult Protective Services (APS) screening and intake process statewide. Researchers conducted two 90-minute focus groups via Zoom with 21 intake and screening staff from 14 counties in Maryland in the summer of 2022. Focus group participants were mostly White and African American women with an average of 6.5 years working in adult services. Interviews focused on understanding challenges in APS intake/screening and strategies to overcome those challenges. Each interview was recorded and transcribed verbatim and three researchers used open and axial coding to identify themes. The key challenge expressed by all participants was the difficulty obtaining adequate information from referral sources, in order to discern whether the adult was vulnerable and if the alleged abuse/neglect/exploitation was being committed by a trusted caregiver or fiduciary as defined by state law. Inadequate referral information results in supervisors/screeners making time-consuming follow-up calls to obtain additional information or cases inappropriately screened in for investigation. This challenge was exacerbated by intake workers inexperienced in APS, understaffing, unclear policies and screening tools for APS, and community partners’ and the public’s unfamiliarity with APS services and policy. Strategies to overcome these challenges included additional staff training, public education, additional resources for APS, clearer policies, and improving the APS screening tool. Quality improvement strategies developed from this study that are relevant to APS systems nationwide will be discussed.