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HomeMy WebLinkAboutMINUTES - 10232012 - C.69RECOMMENDATION(S): ACCEPT annual report from the Employment and Human Services Department on the Adult Protective Services/Elder Abuse programs. Acknowledge that this program protects dependent adults and senior from financial abuse, caregiver neglect, assault and battery, and self-neglect. Recognize that, when discretionary funds become available in the future, consideration should be given to directing funding to this program. FISCAL IMPACT: None. Report only. BACKGROUND: The Employment and Human Services Department reports on an annual basis to the Family and Human Services Committee on the services being provided to disabled and senior residents in our community by the Adult Protective Services/Elder Abuse Prevention Program. On October 1, 2012 the 2012 annual report was provided. During the discussion at the Family and Human Services Committee meeting, the Committee APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 10/23/2012 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS AYE:John Gioia, District I Supervisor Candace Andersen, District II Supervisor Mary N. Piepho, District III Supervisor Karen Mitchoff, District IV Supervisor Federal D. Glover, District V Supervisor Contact: Dorothy Sansoe, 925-335-1009 I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: October 23, 2012 David Twa, County Administrator and Clerk of the Board of Supervisors By: June McHuen, Deputy cc: C. 69 To:Board of Supervisors From:Family and Human Services Committee Date:October 23, 2012 Contra Costa County Subject:Annual Report to FHS on Adult Protective Service/Elder Abuse BACKGROUND: (CONT'D) discussed the impacts of the services on the lives of residents and other aspects of the program. The Committee agreed that this program was highly worthwhile in keeping protecting disabled adults and elderly. The Committee requested that the attached reports be submitted to the Board of Supervisors with the recommendation that, if discretionary funding should become available in the future, consideration be given to providing additional funding to this program. CONSEQUENCE OF NEGATIVE ACTION: None at the current time. CHILDREN'S IMPACT STATEMENT: Not applicable. ATTACHMENTS Report Page 1 of 7 S:\Committees\FHS\2012 FHS\October\APS Report to FHS 2012.doc Report on the Status of Contra Costa County Adult Protective Services To the Family and Human Services Committee October 1, 2012 Submitted by John Cottrell, Director, Aging and Adult Services For the last two years Adult Protective Services reported to the Family and Human Services Committee on the impact of the drastic cuts to the Adult Protective Services (APS) program in our county. As we described last year, APS is part of a continuum of programs provided by the Aging & Adult Services Bureau of Employment & Human Services Department (EHSD) which all seek to promote maximum independent functioning for elders and adults with disabilities and assisting clients to avoid unnecessary or inappropriate institutional care. Many of the supports that have been available to Adult Protective Services for over a decade have since been dis- mantled due to the current economic meltdown and resulting cuts to programs at the State and County levesl. Since December of 2008 when APS lost 75% of its staffing (reduced from 17 so- cial casework specialists to 6 and from 3 supervisors to 1), Adult Protective Services staff in Contra Costa County continue to carry some of the highest caseloads in the State. The State average for an Adult Protective Services worker caseload is approximately 17-21 cases per month. Our social casework specialists carry on the average of 45-50 cases a month. Last year the County Administrative Officer approved an additional caseworker position for APS. Because of reductions in some support staff, the allocation was able to support that one additional work- er. At the time of writing of this report, an additional position is being sought. It is likely that this position may in part require some minimal county funding. We are requesting that this year, the County be willing to participate in the funding for the Adult Protective Services program. As you know, Adult Protective Services is only funded for emergency response investigations. It is not a case management program. Yet, given the complexity of the reports of abuse that are received by APS, it is unusual that a case will open and shut quickly. This is evidenced by the fact that each month, approximately 300 plus cases are carried over. The majority of the situa- tions that are reported to APS are not quickly resolved. Most of the reports that APS receives require intervention in order to prevent an emergent response. In addition to the already report- ed cases of elder abuse, national research studies indicate that as much as 84% of elder and dependent adult abuse and neglect goes unreported. Findings indicate that the reasons for this are consistent with the reasons for not reporting in other domestic violence/abuse situations: fear of retaliation and increased abuse/harm to the victim, fear of abandonment, and/or lack of trust in law enforcement or other authorities to provide adequate protection. As in the two years preceding this report, on the average, each case worker receives at least one to two new referrals every day. This averages between 21 and 30 new referrals a month per worker. The Statewide recommended caseload for an APS social worker is no more than 11 new referrals a month and a caseload of no more than 25 cases. In Contra Costa, social work- ers currently carry an average caseload of 45-50 cases per month. Economic Hard Times It is no surprise that during the past few years we have seen an increase in the reports of finan- cial abuse (and it is the type of abuse most reported). We expect that trend to continue as long Page 2 of 7 S:\Committees\FHS\2012 FHS\October\APS Report to FHS 2012.doc as there are such severe economic challenges to families. For most financial abuse reported, the suspected abuser is known to the alleged victim and in many cases is a family member. Given this challenge, the APS supervisor is working closely with CASE (Communities Against Senior Exploitation) and is also active with “The Law Center’ that provides legal advice and ser- vices to older adults who have been financially abused. Additionally, the Area Agency on Aging is sponsoring an event this year entitled, “Preventing Elder Financial Abuse”. The event will be held on October 25th and will feature the film, “Last Will and Embezzlement” (a story about Mickey Rooney), another short film from the Department of Justice, as well as a speakers panel. This invitation only event includes C.A.S.E., Senior Cen- ter Directors from all 19 communities, the Sherriff, the District Attorney, the Law Center, the Ombudsman, Senior Legal Services, Adult Protective Services, the Executive Committee of the Advisory Council on Aging, and other distinguished guests. The purpose is to discuss this grow- ing problem and develop some county wide goals and strategies for educating seniors about the risks. The financial attack on seniors is very serious especially as the incidence of identity theft grows. APS is often the first call made and because APS is essentially the hub of elder protec- tion (working with all the county agencies), it is again stressed that this program be supported by our own county. Collaboration and Community Relations The APS supervisor also has revamped and reinstituted community training which is impressive given her responsibilities. She continues to provide training to the following partners in addition to working with the Zero Tolerance Initiatives to develop a county-wide protocol for dealing with domestic violence issues. This work involves developing POST training for law enforcement of- ficers as well as community partners. Below are the partners with which she continues to work: • Adult Continuum of Care (Homeless Shelter Staff) • Children & Family Services after hours staff • City of Richmond Crime Prevention Commission • Senior Peer Counseling • Contra Costa Bar Association Referrals to APS and APS Response Time The types of response are as follows: immediate, 24 hour, three-day, and ten-day and “NIFFI” (non face-to-face). APS has very few immediate or 24 hour response referrals. In this time peri- od (FY 10-11) there were 1,256 referrals assigned a 10 day response time, 27 referrals as- signed a 2-5 day response time, no referrals assigned an ‘immediate’ response time, and 474 referrals assigned as a NIFFI (non face-to-face investigation). 51 referrals were taken but then later ‘triaged out’ for referrals that did not warrant a case assignment. There were 646 calls made to APS that either did not result in a referral and were referred to Information and Assis- tance, to IHSS, to another social service program within the agency, or to a community based organization. Page 3 of 7 S:\Committees\FHS\2012 FHS\October\APS Report to FHS 2012.doc Chart I Report Period -7/1/2011 - 6/30/2012 Response Time 10-day 2-5 days 24 hours Immediate NIFFI None Number of Intakes 1256 27 0 0 474 51 Chart II Contra Costa County Report Date: 7/24/2012 II. CASE PROFILE Cases opened during date range 7/1/2011-6/30/2012 A. CASE PROFILES APS Case Profile Total Cases Elder Cases Dependent Adult Cases Total APS cases 1,712 1,366 346 APS cases with multiple Reports of Abuse 81 71 10 APS-only cases (no active IHSS case within this period) 1,712 1,366 346 APS cases with clients not meeting APS criteria 15 9 6 APS cases opened within 6 mos after prior APS case closing 322 262 60 APS cases opened within 6-12 mos after prior APS case closing 111 84 27 APS cases opened 12+ mos after prior APS case closing 204 171 40 APS cases where client's first County contact was an IHSS Referral 0 0 0 APS case where client's first County contact was an APS Report of Abuse 1,712 1,366 346 Cases where law enforcement was contacted 198 152 46 NIFFI cases 368 243 125 In this next section, please note that even though there are a high percentage of referrals that come from medical providers, the leading type of referral most received is that of financial abuse. Chart III (continued on next page) Contra Costa County Report Date: 7/24/2012 III. INTAKE STATISTICS Intakes (ROAs and I&Rs) received during date range 7/1/2011- 6/30/2012 A. REPORTER CATEGORIES Reporters in Each Category Reporters Financial Providers 207 Medical Providers 662 Social Service Providers 259 Page 4 of 7 S:\Committees\FHS\2012 FHS\October\APS Report to FHS 2012.doc Law & Code Enforcement/Legal Providers 121 Non-Mandated Reporters 482 Financial Providers - by Agency Type Reporters Financial Institution 202 Financial Service Provider 5 Financial Fiduciary 0 Other Financial Provider 0 Medical Providers - by Agency Type Reporters Ambulance Service 27 Dental Service 0 Fire Department 24 Home Health Care 127 Hospital 333 Medical Office/Clinic 88 Mental Health Service 43 Skilled Nursing Facility 19 Other Medical Provider 16 Social Service Providers - by Agency Type Reporters Adult Day Services/Senior Center 15 Licensed facility (Board & Care, Care facility) 3 Adult Protective Services 19 IHSS/Public Authority 28 Eligibility 2 Other County/State Social Service Program 49 Community Programs 61 Schools 17 Private Home Care 5 Other Social Service Provider 60 Law & Code Enforcement/Legal Providers - by Agency Type Reporters Law Enforcement 97 Legal Services/Courts 5 Fire Department 0 Housing Code Enforcement 1 Other Code Enforcement 3 Non-Mandated Reporters - by Type Reporters Relative 233 Other Non-Mandated Reporter 249 B. INFORMATION & REFERRALS Referral to Agencies I&Rs Mental Health 61 Others 119 Legal 106 Home Care/Hospice 24 Page 5 of 7 S:\Committees\FHS\2012 FHS\October\APS Report to FHS 2012.doc Assisted Living/Skilled Nursing/Housing 9 Alcohol/Drug 9 Food/Nutrition 6 Health/Medical/Dental 31 Homeless 5 Transportation 15 Financial 10 Veterans 6 Adult Day Care / Adult Day Health 4 Alzheimers/Dementia 6 Types of Referrals APS receives reports on all types of abuse and neglect of elders and dependent adults. APS continues to work closely with law enforcement, the District Attorney, the Health Department, hospital social workers, the Conservators’ office, and community based providers on finding resolution for very complex situations. As you know, reports of abuse involve caretakers who are often, but not always, family mem- bers. Sorting out the facts in many of these cases takes a great deal of skill, patience, and time. Many reports are multi-faceted in that there are allegations of intimidation, physical abuse, ne- glect, and as we see increasingly, financial abuse. The concerns regarding this issue are esca- lating as we are not seeing much financial recovery and more and more families are impacted by the increased needs of older family members. As in the attachment below, referrals come from all sources: law enforcement, hospitals, social workers from Regional Centers and other rehabilitation centers, family members, concerned neighbors, and from individuals themselves seeking help and protection. Many of the referrals that APS continues to receive are those of self-neglect. These are some of the most difficult to resolve because in many cases, the person who is self-neglecting may also be refusing ser- vices. That person may also have Alzheimer’s’ or another form of dementia that reduces their capacity to actually make an informed decision about accepting services or not. From July 1, 2011 through June 30th of 2012, the APS unit opened 1,722 cases. During this period, there were 661 reports of financial abuse, 512 reports of caregiver neglect, 181 reports of assault and battery, and 1767 reports of self-neglect in which there were identified serious health and safety hazards. The numbers of expected cases of abuse and neglect in all catego- ries are expected to continue to increase as our older population increases rapidly due to the maturing of the ‘baby boomers’. We already have seen increases in most reported types of abuse. Charts IV and V below illustrate number of types of abuse and also self-neglect referrals for this past fiscal year. Page 6 of 7 S:\Committees\FHS\2012 FHS\October\APS Report to FHS 2012.doc Chart IV Reported Types of Abuse, Perpetrated by Others 1897 30 181 36 4 64 512 4 248 607 25 55 131 0 200 400 600 800 1000 1200 1400 1600 1800 2000 Total Abuse by Others Sexual Assault Assault / Battery Constraint / Deprivation Chemical Restraint Over/Under Medication Neglect Abduction Psych. / Mental abuse Financial abuse Abandonment Isolation Other Chart V Reported Types of Abuse, Self-Neglect 1767 434 155 444 496 202 36 0 200 400 600 800 1000 1200 1400 1600 1800 2000 Total Self-Neglect Medical Malnutrition / Dehydration Health & Safety Hazard Physical Financial Other Length of Time Cases Are Open In this past year we have been able to cut down the length of time cases are open from an av- erage of 4-6 months to 2-3 months. This has largely been achieved by having a dedicated in- take social worker and supervisor who have been working closely with the staff to find re- sources. Current staffing Currently, the APS program consists of one unit: one supervisor and seven permanent APS so- cial casework specialists. The unit currently has one clerk and has a .5FTE secretary. We con- Page 7 of 7 S:\Committees\FHS\2012 FHS\October\APS Report to FHS 2012.doc tinue into this year with one of the SCSII caseworkers being a dedicated intake social worker. She, because of her expertise, is able to make collateral calls and do extensive fact finding which helps save the investigators time and essentially acts as a triage for cases assisting the supervisor. The intake social worker also is assigned a good percentage of the non face-to-face investigations. As mentioned above, we anticipate that the Board of Supervisors and County Administrative Officer will agree that this year it is time for the County as well to invest in the APS program. Future Planning As reported last year, according to the latest US Census, almost 11% of the 36 million residents in California are 65 or older. Its most recent estimate is that Contra Costa County residents over age 54 constitute 11.5% of the county's population, or about 118,000 individuals. The fastest growing segment of the population in Contra Costa County is the 85+ age group. Over the next 10 years, this group is predicted to skyrocket by 55%. The 65+ age group is ex- pected to increase by 37%. Given these facts, The APS Program will need more than the current one supervisor and seven or eight social workers to be able to handle the needs of our County’s residents. RECOMMENDATIONS We ask that the Family and Human Services Committee acknowledge the funding challenges the APS program is facing and, if funding becomes available in the future, that FHS provides their support during the annual budget process for requests to increase appropriations and add staffing.