November 22, 2014

DCF's Other Problem

Cynthia Barnett | 10/1/2002
The Department of Children and Families, the beleaguered agency charged with protecting abused children in the state, is also responsible for another vulnerable population of Floridians: The elderly.

Each week, DCF's adult services program receives hundreds of reports alleging abuse, neglect or exploitation of elders. The cases involve seniors of all income levels and run the gamut from domestic violence to financial crimes. A recent day on the road with a Broward County investigator started in a low-income neighborhood in Hollywood, where codes enforcement had called in DCF to check on a cantankerous man living in a rat-infested home with a dangerously crumbling roof. The investigator's day ended at a high-rise condo east of A1A in Pompano Beach: A bank employee had reported that the neighbor of an affluent, 91-year-old widow was trying to gain access to her accounts. Like many such seniors in Florida, neither had family in the state.

As might be expected in a state where the over-60 population is 22% and climbing, reports of elder abuse have increased dramatically in the past few years. But the resources devoted to the problem have not. As Florida's child-abuse crisis occupies the spotlight, the state has slipped into a similar crisis in the protection of its most vulnerable elders.

Reports of adult abuse statewide have increased from 29,408 to 41,547 in the past four years. But the number of investigators assigned to respond to those calls increased by only five, from 206 investigators statewide to 211. Overall, DCFs adult-services budget declined 4% as reports of adult abuse increased 41%.

The percentage growth in elder-abuse reports was slightly smaller than that of child-abuse reports during the same period, and political heat on children's issues this year led DCF managers to siphon resources away from seniors temporarily. But between the reassignments of adult-protective investigators to help find missing children and a DCF hiring freeze, some districts' adult-protection units were understaffed by as much as 50% this summer.

The math adds up to huge caseloads: While DCF standards say investigators should get no more than 12 new adult-abuse cases each month, some are getting as many as 30. In one rural district, social workers legally required to call the state's hot line if they suspect elder abuse or neglect told Florida Trend that they have quit doing so out of frustration with the state's handling of cases. Instead, they have helped victims directly into hospitals or nursing homes -- the expensive types of interventions the state wants to avoid.

"Everything you are hearing about the children's side -- it is just as horrible on the adult side," says a hospital social worker. "The population is just as vulnerable, and the agency is handling it just as badly."

Ill-equipped
At the Hillsborough County Sheriff's Office, Georgia Veitch, a detective who investigates crimes against the elderly, says she's also come across professionals who refused to call DCF in cases of elder abuse. "In my 20 years in this field, I've never seen it this bad," says Veitch, referring to both the squeezed state resources and the increasing abuse against elders.

The workload at DCF falls on an investigative force that is unevenly skilled and trained. DCF's adult protection team has less turnover than its counterpart dealing with children's cases, and many adult-abuse investigators are clearly competent. But pay -- salaries start at $28,000 -- minimum qualifications and other factors virtually assure that some are not. There's no higher pay for experience; no incentives for seeking education or other expertise.

As a result, some investigators are not qualified to deal with complicated geriatric or mental-health questions. And while some districts contract with psychologists who can help evaluate a victim's mental capacity, most investigators around the state are on their own.

In a Palm Beach County case last year, the agency made the wrong call. Notified repeatedly by neighbors who said 73-year-old Clarence Lewis of Lake Clarke Shores was unable to care for himself and living in a home infested with rodents, a DCF investigator interviewed Lewis outside his home and found him competent to stay there. A roofer who had seen the conditions inside, killed rats and took photos, made urgent follow-up calls, and the investigator agreed to keep the case open. But she'd done nothing by the time a new report came in one month later. Lewis had suffered a stroke and was found by police in his home -- alive but being gnawed by rats. He died soon after.

The DCF's 12-page internal report on the case found numerous mistakes by the investigator and managers in the District 9 office, where a management shake-up followed. But the case boiled down to this: The investigator was not properly trained in her job, she did not have the expertise to declare Lewis competent to make his own decisions and her heavy caseload prevented her from devoting more time to him.

Workforce issues are only half the problem. While the state's general policy is to contract for low-cost services like housekeeping and home healthcare to try to help elders remain in their homes, it also short-funds those programs. DCF has access to a fund called Temporary Emergency Services, for example, which helps meet a victim's immediate needs, such as food or diapers. But that small pot of money -- $252,000 statewide last fiscal year -- often runs out by spring.

Long-term help is even harder to come by. After DCF investigators stabilize a crisis involving an abused or neglected senior, the state's Department of Elder Affairs is supposed to step in to provide services to keep elders in their homes and out of more expensive nursing homes or adult-living facilities. Terry White, secretary for Florida's Department of Elder Affairs, boasts that 11,000 seniors on a waiting list for those services when Gov. Jeb Bush was elected four years ago have been served.

Meanwhile, however, the number of elders on the list waiting for help has increased in that time by 41% -- to 15,500. White says the state is prioritizing the list so that those in the greatest need are getting help.

In an irony that is certainly not new to the Bush administration, a commission recently appointed by the governor is looking for ways to recruit affluent elderly retirees to a state that can't protect them if they become vulnerable.

Bush, White and others who support the commission say that while Florida's older population provides the state with $2.7 billion from sales and use taxes, it costs the state only $1.28 billion in health and human services expenditures.

Taking steps
At DCF headquarters in Tallahassee, Samara Navarro was named director of the adult services program in May. A longtime elder advocate who came up through the inspector general's side of DCF and was most recently assistant secretary, Navarro has already implemented more rigorous and ongoing training for adult services workers statewide. District supervisors say she's also made clear they're to get rid of investigators who can't cut it performance-wise.

But Navarro's most difficult job is going to be convincing lawmakers that the adult side of DCF needs as much help as the children's side. "I think one of the things the Legislature needs to recognize is that this population is growing -- the number of reports is going to get larger -- not smaller," Navarro says.

"We need to have the resources to properly and competently address those needs," she says, "not just in investigators, but in community services dollars to keep people out of nursing homes. Many times, it doesn't take much money to keep people in their own home."

THE NUMBERS

Statewide Reports to Florida's
Adult-Abuse Hot Line1998-9929,4081999-0035,5192000-0139,5162001-0241,547


Statewide Adult Protective
Investigator Positions*1998-992061999-002062000-012112001-02211*DCF employees who
investigate adult-abuse calls


Total DCF Adult-
Protective Services Budget
(in millions of dollars1998-99$25.811999-00$26.362000-01$23.952001-02$24.77


Elder Abuse: The Problem
Statewide, about 30% of reports to the elder abuse hot line involve neglect by a caregiver.

Another 30% involve cases of so-called self-neglect: A frail, elderly person is unable to care for himself -- an Alzheimer's victim whose caregiver/spouse just died, for example.

12% of the calls involve financial and other sorts of exploitation.

Some 28% are physical abuse -- usually by a family member.

THE PROCESS
When the Department of Children and Families receives a report alleging abuse, a DCF adult protection investigator must respond within 24 hours. The cases involve making hair-fine judgments on seniors' physical and mental health and often their financial affairs.

Often complicating cases of physical abuse is the victim's unwillingness to accuse a relative. Georgia Veitch, a detective in the Hillsborough County Sheriff's Office, shows a photo of an elderly woman with huge bruises on her arms: Someone clearly had grabbed and squeezed her. Veitch suspects the woman's son. But as in most of the domestic-violence cases, "she says she fell ... she was not going to give up her son."

Another complication is that many elders "prefer their circumstances, however bad, to the unknown," says Mitchell Turner, a protective investigator for Hillsborough County. Turner recently investigated a case in which a couple, unable to cook or clean for themselves, were living in a roach-infested trailer with holes in the floor so large that possums crawled in at night. The couple insisted, as is their right, that they would rather live together in squalor and eat one hot lunch from Meals on Wheels each day than move into a nursing home. In those cases, DCF must honor elders' rights to refuse care if they are not in a dangerous situation -- and use the police or courts to intervene if they are. Turner was able to supply some major housecleaning and pest-control services for the couple and build a ramp for the woman, who is in a wheelchair.

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