Adult Protective Services supervisors call for more guardians to help seniors with dementia

Tuesday, June 14, 2016

In recognition of World Elder Abuse Awareness Day (June 15), Council on Aging spoke with our region’s APS supervisors and organization leaders to better understand their work and its challenges.

Lack of funding for APS is a long-standing problem, not only for investigations, but also for basic services that might help vulnerable seniors and families under strain.  Supervisors also said many seniors with dementia can no longer help themselves, but lack family support and need guardianship services.  

Council on Aging care managers frequently work with APS departments when assistance through PASSPORT or the Elderly Services Program may help protect vulnerable seniors. Our Government Relations Manager, Polly Doran, is involved in elder abuse awareness, education, and advocacy activities. And portions of senior services tax levies are allocated to APS in Butler, Clermont, Hamilton, and Warren counties.  

Here are supervisors’ responses and comments, by county.

Butler County

Kevin Kurpieski
Kevin Kurpieski, Supervisor, Adult Protective Services, Butler County

Kevin Kurpieski, Supervisor, Adult Protective Services, Butler County Department of Job and Family Services

Number of investigators/field workers: 5

Number of clients served: 2015 – 464. 2016 to date – 163.

Describe the nature of the allegations: Self-neglect is the most common, comprising at least half of the calls APS receives. The remainder are roughly evenly divided among abuse, neglect and financial exploitation.  Verbal/emotional abuse is the most common, followed by physical abuse. Sexual abuse is by far is the least common true abuse that we see.

To what extent do you think elder abuse is under-reported in Butler County? I think under-reporting is a function of education… I think the other problem that affects the perception of APS (often adversely), is that we have a burden to meet as far as investigating reports.  Sometimes there is suspicion of concern for an elder, but it may be too speculative to warrant the government (APS) ‘intruding’ into the person's life.  If people make reports that are not accepted for investigation, they may not understand why and may lose confidence in the system and not refer future cases out of frustration.

What are the trends?   I do think the heroin epidemic is impacting the elderly population -   to some extent with drug abuse by some seniors, but perhaps even more so within the family where there is potential for a drug abuser to exploit or abuse an elder, and potential for associated neglect. Elders often feel a duty to provide for younger relatives even if they suspect drug use.  In other situations, elders are often exploited financially by consistent emotional and verbal pressure and give in to satisfy the person. 

What are the greatest challenges faced by APS workers?   There are many: personal safety, particularly in dealing with perpetrators; physical health and safety, as far as living conditions, infestations or communicable diseases they encounter.  There is also the frustration you feel when you can see that a person is a victim but they maintain the (mental) capacity to choose not to change their situation.  Even some situations that meet the standards for court action are still not able to be resolved as there simply are not the services or appropriate care setting to meet the person's particular needs.  (Example: a person is at risk and impaired and cannot stabilize at home, but does not meet the level of care for placement in a nursing facility.) 

Time limits are another challenge.  Rapport-building skills are key in APS but we all are limited by time. 

If you had additional funding, what would be your priorities for it and why?  More staff -- ideally more field workers -- or perhaps support staff to assist with certain tasks that the field workers and I could help direct.  I know that since infestations are such a daily concern, it might be good to have one devoted vehicle that is extremely bug-resistant, i.e. no carpeting or cloth, that can be used for particularly intensive infestation cases or transporting of associated clients.  Emergency housing resources and ability to navigate emergency housing or emergency care placements are improving, but emergency housing still often can be a need. 

To report elder abuse in Butler County: (513) 887-4081

Clermont County

David Lytle
David Lytle, Chief Adult Protective Services Investigator, Clermont County

David Lytle, Chief Adult Protective Services investigator and Case Management Coordinator, Clermont Senior Services

Number of APS workers: 3 part-time APS workers. Work includes APS,  homecare case management and guardianship investigations

Clermont Senior Services is the private, not-for-profit agency providing a broad range of services for older adults in Clermont County and has the exclusive contract with the Clermont County Department of Job and Family Services to perform the investigations and follow-up for cases of abuse, self-abuse, neglect, self-neglect and financial exploitation.  The agency's umbrella of services allows for the responding to the immediate service needs of volatile seniors.

Number of allegations/investigations and trends: In 2015, there were 225. Our yearly average since 2000 and before 2011 was approximately 163, but they have numbered more than 200 a year since 2012. From 2011 through 2015, the peak year was 2013 with 264 investigations.

What are the greatest challenges faced by APS workers? The greatest challenge for me is convincing those in authority/with power that someone needs a guardian and placement (in a nursing facility) in an expedient manner.

If you had additional funding, what would be your priorities for it and why? We need to completely fund a professional guardianship program.  The greatest weakness is related to the greatest need.  We need help for elders with dementia who have no family or friends to help them, or no appropriate or helpful family and friends.

To report elder abuse in Clermont County: (513) 732-7173

Clinton County

Clinton County APS
Clinton County APS staff receive an award from Clinton County Commissioners. L-R: Kerry Steed, Kathi Spirk (JFS Director), Patrick Haley, Gina Speaks-Escher (Deputy Director, JFS), and Mike Curry

Gina Speaks-Eshler, Deputy Director, Clinton County Department of Job and Family Services

Number of APS workers: Currently there is 1 shared worker for Clinton County. This worker also performs functions for the Child Protection Unit.

How many allegations of abuse/neglect did you receive in 2015? How many 2016 YTD? In 2015,18 allegations of adult abuse were opened for investigation and assessment. They included: Neglect-10; Abuse- three; Self-Neglect-four; and Exploitation-one. In 2016, so far we have opened nine allegations for investigation and assessment.

To what extent do you think elder abuse is under-reported in Clinton County? It is not known how many adults age 60 and over are suffering from abuse or neglect. In a comprehensive review on elder abuse, Lach and Pillermer (2015) found the prevalence of elder abuse to be approximately 10 percent, including physical abuse, psychological or verbal abuse, sexual abuse, financial exploitation, and neglect. [Lachs, M., & Pillemer, K. (2015, November 12). Elder abuse. New England Journal of Medicine]. Clearly Clinton County’s (APS) numbers do not reflect 10 percent of our elderly population. 

There are a multitude of reasons for lack of reporting. Abused and neglected adults may be afraid to report or don’t want to tell on their child.

What are the trends? At this time, we hesitate to say that there are trends as we are at the beginning of a more comprehensive APS program in Clinton County and in Ohio. This is an area that has been under-reported across the state and has had a lack of consistency and programing on both a state and county level for many years. It is only recently that more attention has been focused on this needed area of services. We foresee, as the programs become more robust and as word gets out, the cases reported and opened across the state and in Clinton County specifically will increase.

What are the greatest challenges faced by APS workers?  Underfunding is one of the greatest challenges to the APS program and provision of services. Ohio Administrative Code allows for the provision of supportive services but there is no funding to support this effort. Guidance is given to county agencies that they should provide these services to the extent of available funds and or resources. Currently there is little funding for this and no ongoing funding that would support any programing outside of investigations of adult abuse and neglect.

Currently Clinton County has no access to guardians who can act on behalf of an elderly person with no family or friends who is suffering from dementia, Alzheimer’s or mental illness, which impairs their ability to provide for their own basic needs.

We also need more education. For example, we had a case where the agency was able to provide an expert evaluation (contracted with Mental Health & Recovery Center of Warren and Clinton counties) and the wife successfully filed and obtained guardianship. However, there is some confusion on the part of other providers such as EMT, fire and police departments as to how to treat a situation like this when a person tries to have their spouse transported for inpatient care but the spouse is unwilling to go.

To report elder abuse in Clinton County: (937) 382-5935 or (937) 382-2449 (24-hr)

Hamilton County

Hamilton County APS workers
L-R: Phil Richardson, Olu Abimbola, Jim Silver, Lisa Pitchford, Dan McCall and Stephanie Hull of Hamilton County Adult Protective Services

Stephanie Conlon Hull MSW/LSW, Adult Protective Services Manager, Hamilton County Department of Job and Family Services

Number of APS workers: 5

How many allegations/investigations of abuse/neglect did you receive in 2015? How many 2016 YTD?  560 in 2015. So far in 2016 we have had 230.

Describe the nature of the allegations:   50 percent of cases are self neglect; 15 percent abuse; 20 percent are neglect; 15 percent are exploitation

To what extent do you think elder abuse is under-reported in Hamilton County?  Current estimates indicate that elder abuse is grossly under reported.  

What are the trends?  The number of calls has increased, however, since our number of staff and supervisors decreased in 2009, we now only take cases of people age 60 and over, and those meeting the criteria of the APS law.  The law says that (for an APS investigation) someone has to be allegedly "suffering from the infirmities of aging, physically or mentally."    

What are the greatest challenges faced by APS workers? The type of cases we are seeing are more complex with challenging family dynamics.

If you had additional funding, what would be your priorities for it and why?  For a while now I have seen a need for case managers to serve the elderly who aren't being abused or neglected or who aren't mentally ill, but need assistance with various tasks of life including; applying for public assistance, moving, applying for subsidized housing, dealing with Social Security, etc. Many of these systems are difficult for seniors to navigate and they may not have family or friends able to help.

To report elder abuse in Hamilton County: 513-421-LIFE (5433)

Warren County

Arlene Boyd, Adult Protective Services Supervisor, Warren County Division of Human Services, shared statistics at the March meeting of the Advisory Council for the Warren County Elderly Services Program.

2016 Investigations Included: Exploitation – 12; Neglect by Others – 11; Physical Abuse  two; Self Neglect  28. There were there were 58 referrals; 203 home visits, three court cases; four intake home visits, and 517 phone calls.

According to Lauren Coleman, Quality Manager for the Warren County Elderly Services Program, self-neglect is a frequent and frustrating part of APS work.  “A lot of families think we or APS can come in and fix everything,” she said. “But we can’t force a person to accept help. Self-determination is a huge component of working with older adults.”

To report elder abuse in Warren County: 513-695-1423