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HomeMy WebLinkAboutMINUTES - 10162001 - SD.2 CONTRAFHS #45 . COSTA TO: BOARD OF SUPERVISORS COUNTY FROM: Family & Human Services Committee DATE: October 16, 2001 SUBJECT: Elder and Dependent Adult Abuse SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATION(S): ACCEPT the report presented by the EHSD Director and Staff on the status of the Adult Protective Services (APS) program. BACKGROUND/REASON(S) FOR RECOMMENDATION(S).- On ECOMMENDATION(S):On August 2, 2001, the Family and Human Services Committee heard the attached report on the status of elder and dependent adult abuse and the. Adult Protective Services (APS) program. This report includes descriptions of changes to the program due to implementation of SB 2199, including funding changes; key program indicators and achievements; and critical issues, challenges, and goals. In response to questions from Supervisor Mark DeSaulnier and Supervisor Federal Glover, John Cullen, Director of Employment and Human Services Department, expressed concern that, just as the program has been gearing up and implementing the provisions of SB 2199, the State of California is reducing funding commitments. CONTINUED ON ATTACHMENT: X YES SIGNATURE: _ RECOMMENDATION OF COUNTY ADMINISTRATOR_RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): MARK DESAULNIER FEDERAL D. GLOVER ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A UNANIMOUS(ABSENT ) TRUE AND CORRECT COPY OF AN AYES: NOES: ACTION TAKEN AND ENTERED ABSENT: ABSTAIN: ON MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. Contact:Dorothy Sansoe,335-1009 )'_0 O C, p��,�, r O I ATTESTED .c yt� (O JOHN SWEETE ,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR cc: CAO John Cullen,EHS Director CI%�k-�JL Bob Sessler,Aging and Adult Services Director BY © ,DEPUTY PROGRAM OVERVIEW Since the 1999 implementation of SB 2199 (Chapter 946, Statutes of 1998), the County Adult Protective Services (APS) Program has been required to respond to and investigate all reports of physical abuse, financial abuse, neglect, abandonment, isolation and abduction involving elders (age 65+) and dependent adults (aged 18-64). The program has changed from a minimally staffed Monday through Friday business day operation capable of responding only to the most serious allegations of physical abuse, to a twenty-four hour, seven days per week comprehensive response system capable of intervening a broad spectrum of adult abuse, neglect, and exploitation. Major changes to APS due to enactment of SB 2199 include the following elements. • The definition of mandated reporters was expanded • APS agencies are now required to respond to and investigate all reports of physical abuse, . financial abuse, neglect (including self-neglect) abandonment, isolation, and abduction. • APS agencies are now required to operate a 24/7 emergency response system. • APS agencies are required to provide case management services which include investigation, assessment of individual limitations, strategies for stabilization, linkage to community services, monitoring and reassessment. • APS agencies are now authorized to establish emergency shelter care and in-home protection services in addition to tangible and nOn-tangible services. FUNDING CHANGES In fiscal year 1996-97, Contra Costa County received approximately $1.1 million in State and Federal Funds from County Services Block Grants (CSBG) and Title XIX. Following passage of 2199, beginning in fiscal year 1998-99, the County began receiving additional State funds earmarked specifically for APS. By fiscal year 2000-01, the County received a total of $3,235,000 in State and Federal funds from the combined sources. KEY PROGRAM INDICATORS The growth and development of the APS program in the last few years is reflected in a variety of program related statistics. Some of the highlights include: • The number of referrals increased by 325% between 1996-97 and 2000-01. • Approximately 50% of confirmed abuse allegations involve self-neglect issues. • Since implementation of SB 2199 in September 1999, over 2,900 reports of alleged abuse or neglect have been received. • 81% of active cases involve elder abuse and 19% involve younger adult abuse. • Approximately 24% of APS cases remain open three months or longer. • California State Department of Finance projects California's elder population (aged 60+) is projected to increase by 23% in the next 10 years. Correspondingly, Contra Cost County's elder population would increase from 156,000 in 2001 to 192,000 in 2010. 2 •. ADU� � c �Co�����`��V� . SE�@�I1 �' -�� ����� � �3 ��E��L� ��� e. STATUS OF ADULT PROTECTIVE SERVICES (APS) PROGRAM is 1. Program Overview Since the 1999 implementation of S132199, the County Adult Protective Services (APS) Program has been required to respond to and investigate all reports of physical abuse, financial abuse, neglect, abandonment, isolation and abduction involving elders (age 65+) and dependent adults (aged 18-64). The program has changed from a minimally staffed Monday through Friday business day operation capable of responding only to the most serious allegations of physical abuse, to a twenty-four hour, seven days per week comprehensive response system capable of intervening in a broad spec- trum of adult abuse, neglect, and exploitation. County social service departments are responsible for investigating allegations of abuse of an elder or dependent adult residing in other than a long-term facility. Abuse that occurs in a long-term care facility is reported to and investigated by the Long Term Care Ombudsman Program, operated under the guidance of the Area Agency on Aging. 2. New Law/SB 2199: Prior to the implementation of SB 2199, APS was minimally funded with no real statewide mandates or standards. SB 2199 created a statewide APS Program with statewide minimum standards and was fully implemented May 1, 1999. Major changes to APS due to enactment of SB 2199 include the following elements: ❖ The definition of mandated reporters was expanded. Prior to SB 2199, medical personnel, care custodians, social workers and law enforcement agents were required to report elder and dependent adult abuse within the scope of their employment responsibilities. With the implementation of SB 2199, man- dated reporters now include any person who has assumed full or in- termittent responsibility for the care or custody of an elder or depend- ent adult. (Attachment 1.) ❖ APS agencies are now required to respond to and investigate all re- ports of physical abuse, financial abuse, neglect (including self- neglect), abandonment, isolation, and abduction. Prior to SB 2199, man- dated reporters were only required to report physical abuse of elders and de- pendent adults. APS agencies were authorized, but not required, to provide pro- tective activities, such as investigations and need assessment. ❖ APS agencies are now required to operate a 24-hour emergency re- sponse system that provides in-person response 24 hours per day, seven days per week. The 24-hour system allows counties to provide imme- diate intake or intervention for new reports involving immediate life threatening situations and to respond to crisis situations in existing cases. ❖ APS agencies are required to provide case management services which include investigation, assessment of individual limitations, strategies for stabilization, linkage to community services, monitoring, and reas- sessment. Prior to SB 2199, APS agencies would respond to, at a minimum, al- legations of physical abuse, stabilize the situation, and utilize available social ser- vices and community resources. Counties were not required to conduct ongoing case management services. ❖ Besides providing casework intervention services, APS agencies are now authorized to establish emergency shelter care and in-home pro- tection services in addition to tangible and non-tangible services, such as, emergency food, clothing, repair/replacement of essential appli- ances, transportation, etc. Prior to the implementation of SB2199, County APS programs lacked the financial reserves and programmatic jurisdiction to re- spond to critical emergency housing and other service needs of the clients. 3. FUNDING CHANGES Beginning in 1984 the APS program was funded under the County Services Block Grant (CSBG) program. In addition to APS, the CSBG allocation of State funds and matching Title XIX Federal Health Related funds provided for other adult social service programs such as Information and Referral, Out of Home Care for Adults and Lanter- men-Petris-Short (LPS) Conservatorship intake. In FY 1996-97, Contra Costa County received approximately $1,140,000 in State and Federal Funds from CSBG and Title XIX. Following the passage of SB 2199, beginning in FY 1998-99, the County began receiving additional State funds earmarked specifically for APS. By FY 2000-01 the County received a total of $3,235,000 in State and Federal funds from the combined funding sources. Attached you will find a chart specifying the amount of State and Federal revenue available for APS and related adult social service programs over the last five (5) fiscal years. (Attachment 2). 4. Operational Impact of SB2199 The availability of increased funding under SB 2199 has led to major changes in the Contra Costa County APS program. Increased Staffing - Since the passage of AB 2199 into law, the APS unit has experienced a tremendous expansion in staff in order to meet legislative mandates. The unit went from a staff of 3.0 social casework specialists, a .5 su- pervisor and a .5 clerk to a staff of 14 Social Casework Specialists, 2.5 supervi- sors, 1 Public Health Nurse and 1 Mental Health Clinical Specialist and 2.5 clerks. As a consequence of this growth, expanded office space and equipment and supplies have needed to be provided. 2 24/7 Response -The new law demands adult protective services agencies provide free public telephone access to a 24-hour hotline system to receive reports of known or suspected abuse or neglect. Access to APS services in Contra Costa needed to be ex- panded from weekdays to 24 hours 7 days per week. In order to meet this require- ment, a contractual agreement was established with the Contra Costa Crisis Center to receive after hour's calls. This in turn required after hours staffing by APS, which in- cludes an on call social casework specialist and supervisor. If necessary, after hours staff will take immediate action upon receiving a call. Additionally, training is now pro- vided by APS staff members, to the volunteer staff of the Crisis Center to enable them to assess calls for appropriate referral to on-call staff. Expansion of Multi Disciplinary Team (MDT) Meetings - The law defines multi disciplinary team personnel as those persons who are trained in the prevention, identifi- cation and treatment of abuse of elders or dependent adults who are qualified to pro- vide a broad range of services related to abuse of the elderly or dependent persons as defined [WIC 15753.5]. The MDT is required to meet to discuss complex and difficult cases and to resolve casework issues. Previously these meetings were bi-monthly and were coordinated and led by, the non-profit organization, Elder Abuse Prevention, Inc. Now, designated APS staff are responsible for these meetings and convene them monthly. Centralized Screening and Intake - With the increase in the number of cases requiring investigation, a more efficient screening and intake method was needed. Calls of suspected abuse are centrally handled by Information and Assistance (I&A) staff that screen them for referral appropriateness. The I&A worker then completes the State re- quired abuse reporting form and delivers the referral information to the APS unit for ac- tion. Outreach - Due to the advent of an expanded definition of elder abuse and the broadening of the number of mandated reporters, an APS social worker is now dedi- cated half time to training mandated reporters, presently targeting police and fire per- sonnel, regarding the new legally mandated reporting requirements. A mandated re- porter is defined as any person who has assumed full or intermittent responsibility for care or custody of an elder or dependent adult. In the future, training efforts will be expanded to include other mandated reporters, such as administrators, supervisors, and other licensed staff of a public or private facility that provides care or services for elder or dependent adults, "care custodians", and health practitioners. Purchase of Tangible Services - The law now states that each county APS agency shall provide tangible services to protect clients to the extent resources are available. These services may include, but are not limited to food, clothing, repair of es- sential appliances, transportation emergency response units, and emergency medical supplies. While this mandate allows staff expanded opportunity to quickly provide such items, it also involves significant additional time in assessment, care planning, time 3 spent on ordering, purchasing and delivering of necessary items. Additionally, contracts have had to be drawn up with approximately two-dozen vendors who provide the goods and services. Emergency Shelter - Emergency shelter and in-home protection must now be provided on a temporary basis, in those cases involving immediate life threats, immi- nent danger, or crisis until the dangers at home can be resolved. The APS program now contracts with motels, licensed residential care facilities and skilled nursing facilities to provide this emergency capability. 5. Key Program Indicators The growth and development of the APS program in the last few years is reflected in a variety of program related statistics. Provided below are charts that summarize some of the key statistical indicators of the APS program. Some of the highlights of information provided in theses charts include: ■ the number of APS referrals in FY 2000-01 was 325% greater than in FY 1996-97, O ■ approximately 50% of confirmed abuse allegations involve self-neglect issues, ■ since the September, 1999 implementation of S62199, we have received over 2,900 reports of alleged abuse or neglect, ■ 81% of our active cases involve elder abuse and 19% of our cases involve younger adult abuse, ■ about 24% of APS cases remain open three months or longer making an ever increasing demand for case management services from our casework staff and for multiple tangible services such as respite care, home modification, nutrition services, chore services and Conservatorship. A. APS Referrals; 1996/97 — 2000/01. (Attachment 3) B. Percentage Distribution of Types of Confirmed Elder and Dependent Adult Abuse. (Attachment 4) C. Active Cases by Month. (Attachment 5) D. Average Length of Time a Case Received Services and Remained Open. (Attachment 6) E. Perpetrator vs. Self-Neglect Referrals. (Attachment 7) F. Confirmed and Inconclusive Perpetrator Abuse. (Attachment 8) 0 4 6. Projected Growth ■ According to the State of California's Department of Finance (County Pro- jections, December 1998) California's elder population (aged 60+) is pro- jected to increase by 23% in the next 10 years from 3.7 million to ap- proximately 4.5 million. ■ Correspondingly, Contra Costa County's elder population would increase in the next 10 years from approximately 156,000 in 2001 to 192,000 in 2010. ■ According to the California Department of Finance, about 4 to 5 percent of the elder population are at-risk of being abused. In Contra Costa County, this means that today approximately 7,800 elders are at-risk of being abused. By 2010, the at-risk elderly population in Contra Costa will grow to approximately 10,140 persons. ■ Based on the active caseload reported on APS monthly statistical reports, we are currently serving less than 5% of the at-risk elder population. In future years, as the visibility and effectiveness of the APS program in- creases, we anticipate receiving referrals involving a much higher per- centage of the at-risk population. Thus, it is a virtual certainty that there will be a very significant growth in the demand for APS services in coming years. 7. Challenges for Other County Departments Health Services Department - The increased ability of APS to investigate and in- tervene in elder or dependent adult abuse cases, coupled with the addition of a Public Health Nurse to the staff, increases the demand for health services through utilizing the County Regional Medical Center emergency room for treatment and health clearances for emergency shelter placement. Mental health services are also impacted due to the broader definition of elder abuse that now includes self-neglect. Self-neglect cases are often due to mental illness or dementia. These same cases increase the referrals from APS to the Public Guardian for both conservatorship and money management services. County Counsel - More County Counsel time is being requested by APS to assist in clarifying issues that have arisen from the regulatory mandates and from the Public Guardian to process the increase of conservatorship cases. District Attorney - A Deputy District Attorney and Investigator have been assigned to serve the increased APS cases. Consequently, more cases are being brought to the court system for prosecution. The DA is also providing training on the new law to county police jurisdictions. Since financial abuse is one of the most frequently reported forms of elder abuse, the District Attorney is also developing a Financial Abuse Special- 5 ist Team (FAST). Similar to the Multi Disciplinary Team, FAST membership will include those from the public and private network who deal with issues specific to fiduciary abuse. The primary goal of the FAST will be to decrease elder financial abuse by pre- vention and effective intervention through group consultations and educational forums for service providers, members of the financial community and the public. Interagency - There now exists a significant need for increased integration of ser- vices between all departments affected by the new APS law. Currently the Health Ser- vices Department and Employment and Human Services Department are exploring joint Information and Assistance activities to address the inter-departmental issues that can arise when providing comprehensive services to an abused elder or dependent adult. As time goes on, other County departments may need to be included in these efforts. 8. Community Impact APS program expansion has had a significant impact on a variety of different com- munity groups. Victims: The new reporting mandate now includes not only physical (including sexual) abuses, but also the following: • Abandonment O Abduction • Isolation • Financial Abuse • Neglect (including self-neglect) The increase in mandated reporters; the 24/7-response system and the availability of emergency shelter will provide victims with greatly improved access to protective services. The APS program faces the major challenge of informing victims and those concerned about them of our increased capability to protect them. Mandated Reporters - The new law greatly broadens the definition of reportable offenses and who is mandated to be reported. Now both professional and unpaid care- givers are responsible for reporting suspected abuse and are subject to the same penal- ties for failing to report. This penalty is a misdemeanor, punishable by up to six months in county jail or by a fine of up to $1,000, or both imprisonment and fine. Newly man- dated reporters need to be well informed on their responsibilities as well as issues re- lated to abuse such as recognition, intervention, reporting procedures and resources available to victims. Community Supportive Services — The APS program is making an increasing demand for services from those agencies providing home care, adult day care, home O delivered meals and money management as they can often supply the services needed to keep vulnerable elders and dependent adults in their own homes. 6 Private Vendors — The expanded APS program purchases needed tangible items or services for APS clients from community businesses. These purchases not only pro- vide these businesses with added income, but also give them knowledge of APS and make them secondary partners in caring for clients. All of the community impacts listed above create a ripple effect upon the public's knowledge of elder and dependent adult abuse problems. Through heightened aware- ness, our community improves its ability to protect this vulnerable population and ulti- mately reduce the occurrence of abuse and neglect. 9. Expanded Prevention Services/Self-Neglect Intervention The Aging and Adult Services Bureau is in the process of forming an Adult Protective Services/Linkages Case Management Unit. Both Adult Protective Services and Linkages serve clients 18 years of age or older at risk, both use standard case management processes and both programs have similar regulations with similar time frames for criti- cal case activities. Additionally, both programs have many common goals such as; pro- viding intervention activities directed toward safeguarding the well being of elder and dependent adults; linking the elder or dependent adult with appropriate community based resources, promoting self-sufficiency; and attempting to create a stable environ- ment where the individual can safely function without requiring additional intervention. The Linkages (APSL) Unit will be a specialized unit of Social Casework Specialists and support staff dedicated to providing case management services to clients who meet the criteria for the Linkages program or Adult Protective Services cases and are identi- fied as self-neglect cases. It was decided that creating a combined, specialized unit would develop the expertise to deal with such cases more efficiently and effectively. Such self-neglect cases have emerged as the largest single category of APS case. They largely overlap the criteria for Linkages case management cases, and they tend to be the most problematic and long-term of the cases handled by APS. Another key component for APSL services is the provision of money management services. We are in discussions with the Health Department's Probate Conservator pro- gram to arrange for bill paying and representative payee services for clients no longer able to manage their own financial affairs and who are too impaired to use community volunteer money management programs. The APSL unit will also have staff available to. assist with locating alternative hous- ing, client transportation and escort, shopping/errands, scheduling medical appoint- ments, courier service/document deliveries, restraining orders, pick up medications, etc. 10. FY 2001-02 Goals to A. APS/Linkages — Pending approval of the FY 2001-02 County Budget ap- propriating the necessary funding, we plan to fully implement a new 7 APS/Linkages unit serving clients with self-neglect problems. This pro- gram expansion will involve hiring and training a unit of Social Casework Specialists, Social Workers and Social Service Program Assistants to pro- vide comprehensive screening, assessment, case management, and tangi- ble services for adults at risk of self-neglect. B. Community Resource Development — APS staff are working cooperatively with Area Agency on Aging staff and the Long Term Care Integration Pilot Project to increase the capacity of local community agencies to provide needed home and community based services for APS clients such as res- pite care, home modification, caregiver support, nutrition services, medi- cation management and chore services. C. Expansion of Public Guardian/Conservatorship Services — Pending approval of the FY 2001-02 County budget appropriating the necessary funding, we hope to reach an agreement with Health Services Department/Mental Health Division for expansion of Public Guardian/Conservatorship services to include probate conservatorship for non-institutionalized APS clients still living at home and for expansion of Public Guardian money management services for APS clients too impaired for community volunteer money management programs. D. Information and Assistance Enhancement — Cooperating with Health Ser- vices Department to perform comprehensive medical and social screening and intake for APS clients with health care needs. E. Expansion of Health Care Consultation — Increase amount of public health nursing and mental health clinical consultation purchased from Health Services Department to meet increasing caseload demands and initiate purchase of substance abuse consultation for APS clients. F. District Attorney Services — Advocate for expansion of District Attorney Elder Abuse Unit to accommodate increasing number of criminal referrals from APS and for establishment of Financial Abuse Specialist Team to pro- vide regular venue for in-depth interdisciplinary review of APS cases in- volving fiduciary abuse. G. Expanded Community Outreach and Training — Expand APS staff commu- nity outreach to publicize elder and dependent adult abuse issues, the availability of APS services, and to train mandated reporters regarding their reporting obligations. H:\Sessler\Budget\Report to Fam&Human Svs Comm.doc 8 CHANGES IN THE CALIFORNIA ELDER AND DEPENDENT ADULT ABUSE REPORTING LAW (15630 W & I) RESULTING FROM SB 2199, EFFECTIVE JANUARY 1, 1999 WHAT HAS CHANGED? OLD LAW NEW LAW Expanded to include persons providing care People whom, in their whether or not paid, and whether full time or in- termittent; definitions of care custodian and health TO WHOM DOES THE within the scope of their Practitioner now more detailed to be more inclu- LAW APPLY? employment, observe or sive. Notable additions: workers in publicly funded suspect physical abuse. In-home care agencies, independent living cen- ters, area agencies on aging, court investigators, protection and advocacy agencies; support and maintenance staff now included Physical abuse, abandonment, isolation, financial WHAT MUST BE Only physical abuse abuse, and neglect; definitions of financial abuse REPORTED? and neglect broadened (neglect includes self- neglect) Same as before, plus: you have "knowledge of an incident that reasonably appears to be" one of the above types of abuse, or you "reasonably suspect" Only when, in the course of abuse; except.- you no longer need report abuse UNDER WHAT your employment, you learn the victim reported to you if the victim is known to CIRCUMSTANCES IS of the physical abuse by you to be mentally deficient, you are not aware of ONE OBLIGATED TO witnessing it, being told by any independent evidence of the reported abuse, victim that it occurred, or and you reasonably believe that the abuse did not REPORT. you see injuries or evidence occur' (similar exception allowed for nursing home in the victim that can only incidents where proper procedures were being reasonably be explained by followed - to discourage individuals with ulterior abuse motives from filing reports intended to harass or embarrass facilities) Immediately or as soon as HOW QUICKLY MUST Practically possible by ONE REPORT> phone, with written report No change. following within two work- ing days. PENALTY FOR FAILURE Up to $1000 fine and/or 6 Same, unless great bodily injury or death results, TO REPORT? months in jail in which case maximum penalty increases to $5000 fine and/or one year in jail. Anything other than physi- Any types of abuse not specified above. Not many WHAT MAY BE cal, plus physical if only are left, but seems to include: treatment resulting REPORTED BUT IS NOT suspected or learned about only in emotional or mental suffering, threats of REQUIRED? from a third party abuse, or when the victim's "emotional well-being is endangered in any other way" Effective 1/1/2000,this exception will be limited to medical doctors, registered nurses,and psychotherapists, per changes enacted by AB 739. H:\Sessler\Budget\Report to Fam&Human Svs Comm.Adach 1.doc ATTACHMENT 1 Z Z �•: (=>-m u1 W r; ' n .^� : .oNp k Lr) Ln: (7 00 M :�_i Ln. N W M Q1 M V M O •,� Q1 N I� N 00 „ . W 0 ,--i ,--i N M N mm! OMOtnN r-J, NO _O ' ,;.:,moi:`•;';: . ` Z �. ,--�. 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U O O C: a O E E O O E E v� Co + N CO C0 1 0 0 0 0 El m R�l NO.-O-1 0 0 � C. 4) CO J.: CO CL k cv M. > O oocu 0 LM ■� U o U > 0 T Q \ co Ncli N •• U O • I C/) N U 7 O U) PERPETRATOR VS SELF-NEGLECT REFERRALS Data September 1999 -May 2001 ELDERS 49% ❑Perpetrator 51% ❑Self-neglect DEPENDENT ADULTS 46% ❑Perpetrator 54% ❑Self-neglect • ATTACHMENT 7 CONFIRMED AND INCONCLUSIVE PERPETRATOR ABUSE Sept 1999 - May 2001 CONFIRMED PERPETRATOR ABUSt. Mental Suffering Physical 25% 25% Isolation Sexual 2% 2% Neglect 17% Abandonment Financial 2% 27% • INCONCLUSIVE PERPETRATOR ABUSE Mental Suffering Isolation Physical 11% 4% 20% Sexual �'-• 3% Abandonment 31% Financial Neglect 29% 2% SOURCE: SOC 242 Contra Costa County ATTACHMENT 8