A Day in the Life of Adult Protective Services Prepared by County Welfare Directors Association of California,

What is “A Day in the Life of APS”? This project captured and analyzed data about the reports APS received in California during a 24 hour period on March 5 th 2004.

Project Design Each of the 58 counties was given a spreadsheet to record all APS referrals received on March 5 th :

Purpose of the Project: To “put a face on APS” by educating the reader about the: 1. types of clients who are at risk; 2. array of calls received; and 3. complexity of the issues involved.

Project Limitations This project does not address: the results of the investigation the case management services offered or the end result of the interventions.

Background Information APS in CA. is administered by 58 counties APS is a 24/7 program Definitions: Elder=65 years and older Dependent adult= Any person between the ages of 18 and 64 (who) has physical or mental limitations that restrict his or her ability to carry out normal activities or to protect his or her rights,..., including any person between the ages of 18 and 64 years who is admitted as an inpatient to a 24-hour health facility.

Background Information Types of abuse recognized in California Abandonment Abduction Financial Abuse Isolation Mental Suffering Neglect Physical Abuse, including Sexual Abuse Self Neglect

Sample Vignette 211 The victim is an elderly woman with senile dementia whose husband and sole caregiver had just committed suicide by shooting himself in their home. The victim was unable to care for herself. She did not know when to take her own medications and has no family in the area. Immediate response by APS was requested.

Sample Vignette 148 A 74 year old man was found by his caregiver after being on the floor of the home for two to three days. The paramedics were called. The victim was dehydrated and transported to the hospital.

Sample Vignette 256 The 18 year old male victim is autistic, developmentally disabled, and psychotic. His caretaker parents do not obtain needed medication or mental and physical health services for him. They also leave him alone with relatives who had abused him as a child.

Sample Vignette 61 While an 81 year old woman was hospitalized for open heart surgery, her half brother got her to sign a power of attorney and a quit claim deed. He then sold her house without her knowledge or consent. The police are unwilling to press charges because of the power of attorney.

Gender of Elder Victims Males 37% Females 63%

Male/Female Ratio of Victims 65+

Gender of Dependent Adults Males 46% Females 54%

Ratio of Elders to Dependent Adults Dependent Adults 28% Elders 72%

Victims with Cognitive Impairments

Victims’ Ages

Victims over 80 Age 80+ (37%) Ages (63%)

Comparison of reports to population

Victims with medical issues

All types of abuse Assault 15% Neglect 23% Financial 17% Psych 14% Self-neglect 26%

Self-neglect Physical care 21% Medical care 34% Health and Safety Hazards 31% Malnutrition/ Dehydration 6% Other (e.g. financial) 8%

Abuse by others Physical 20% Isolation 4% Financial 24% Neglect 31% Mental Suffering 19%

Perpetrators Caregiver 16%Family 42% Self 31% Friends 3%Counselor 1% Business 7%

Reporters Referral SourceNumber Family Member/Relative45 Hospital/Social Worker38 Self30 Case Manager/Social Worker29 Friends and Neighbors21 Home Health Agency/SW19 Medical Personnel18 Law Enforcement15 Mental Health Personnel13

Family Violence Family Violence 22% Other Abuse 78%

Domestic Violence

Other findings 7 suicide related calls 10% of reports indicated the victim or perpetrator had drug or alcohol issues. 6% were Regional Center clients.

Perspective on results This is only a snapshot- not the whole picture. This was a slow day for APS in California (Average = reports per day vs 327 reports received March 5). Historically, California receives approximately 16% to 25% of the adult abuse reports nationwide. The National Elder Abuse Incidence Study 2, completed in 1996, indicates that only 16% of all abuse is reported. If that percentage is correct, an additional incidences of abuse occurred and went unreported in California alone on March 5, 2004.

Conclusions 37% of the abuse victims are % of the elderly victims are female. 64% of the victims have major medical issues. 53% of the victims are described as exhibiting some degree of cognitive impairment. 26% of the victims of all types of abuse are self- neglecting. If abused by others, 31% of victims are experiencing neglect and 24% are reported as experiencing financial abuse.

Conclusions 42% of the alleged perpetrators are family members. Family members and health care providers make the majority of the calls to APS. The complexities of the abuse issues indicate that the victims are likely to need interventions from more than one agency (e.g., mental health, law enforcement, in-home supportive services), reinforcing the importance of multidisciplinary teams in the treatment of adult abuse.

Next Steps Further research Development of an “All-County” data collection system More training for county APS staff and multi- disciplinary team members Increased funding for these crucial programs is needed Support for federal action to combat adult abuse