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Elder abuse hot
lines enable reports of self-neglect
(March 2008
Issue)
By Nan Shnitzler
Social service bureaucracies can seem Byzantine, but thanks to
Adult Protective Services (APS), most states have a single point
of contact to report situations in which vulnerable adults may be
at risk for abuse, exploitation or neglect. Whether called help
lines, hot lines or information lines, assistance is usually 11
digits away, often toll-free and with a live voice at the receiving
end in most New England states.
In Massachusetts, the Office of Elder Affairs administers the Protective
Services Program. It has established 22 protective services agencies
employing 169 caseworkers and 44 supervisors to respond to reports
of elder abuse via the 24/7 hot line, which received 14,317 calls
in fiscal 2007, e-mailed spokesperson Alison Goodwin.
Rhode Island's Department of Elderly Affairs (DEA) last year ditched
an after-hours answering machine in favor of a crisis intervention
team contracted out to Family Service of Rhode Island. With $113,000
in state funds for a year-long trial, a team of master's level geriatric
specialists handles urgent needs - everything from filling in for
caregivers to working with law enforcement to initiating referrals.
"We were always mandated to have a 24/7 report line, so what we
did is try to create a seamless calling and reporting system for
caregivers, elders themselves and anyone else needing to report
in," says Corinne Calise Russo, MSW, DEA director.
Each morning, DEA staff gets reports of the evening's activities
and makes plans for follow-up. The after-hours team is so invested
that the staff meets with them monthly to let them know how their
clients are faring.
While elder abuse is typically thought of as caused by a third
party, out of Rhode Island's nearly 300 after-hour calls from May
through December, about 43 percent pertained to self-care concerns
and 14 percent related to mental health issues.
"It's unlikely they [elders] will make an appointment to see a
counselor [because of the stigma]. No one has given them permission
that it's okay, including their primary care physician," Russo says.
"Therein lies a problem."
Russo is gratified that elders themselves are calling in. She thinks
they feel the hotline provides a secure, confidential venue in which
to report abuse, exploitation or self-neglect.
"What we're finding is our self-neglect cases are increasing tremendously.
We have more self-neglect cases in Rhode Island than elder abuse,"
Russo says.
Other New England states see a similar trend. Of the 3,841 cases
opened in Connecticut last fiscal year, half were related to self-neglect
and most came via the hot line, says Pamela Giannini, MSW, director
of aging services for the Department of Social Services.
During business hours, Connecticut's toll-free hot line is routed
to the nearest Elder Protective Services office. After hours, calls
are diverted to the 211 Info line (which has an out-of-state toll-free
number), which will beep a state-trained intake person who has broad
discretion to handle urgent matters.
APS in Maine has one state-funded nationwide toll-free intake
number 24 hours a day that covers adults 18 and older, says director
Karen Elliott, LSW. One of three regional caseworkers that receive
after-hours calls determines whether the situation can wait until
morning. If not, they contact an on-call person who may go on-site
or enlist the help of emergency responders.
The number of referrals for investigations has been increasing,
from 2,986 to 3,510 in the last two fiscal years, Elliott says.
About 72 percent of the calls are for adults 60 plus. After-hours
calls have remained steady at nearly 2,500 annually and while most
of them pertain to ongoing cases or guardianship issues, there's
been an eight percent increase in after-hours referrals.
"Maine is aging. The economy and the cold winter especially influence
these calls," Elliott says, speaking for all of New England. "If
you look nationally, part of elder abuse is self-neglect and that's
a large number. Sure the numbers of substantiated cases of physical
abuse and financial exploitation have increased every year. But
when you look at elder abuse, you have to factor in self-neglect."
Data from a 1988 survey suggested that one in 14 incidents of elder
abuse in domestic settings, excluding self-neglect, came to the
attention of the authorities. A 1998 National Center on Elder Abuse
study said nearly 450,000 adults aged 60 plus were abused in domestic
settings, but self-neglect cases increased the total to 551,000.
Robert B. Blancato, MPA, national coordinator of the Elder Justice
Coalition, says the Senate special committee on aging contends there
may be as many as five million annual cases of elder neglect, financial
exploitation, and sexual and physical abuse, but no one can dispute
that aging baby boomers is an emerging national concern.
Several factors suggest abuse could get worse, Blancato says. First,
48 percent of women aged 75 and older live alone, according to the
federal Administration on Aging; and secondly, 75 percent of all
wealth in the country is controlled by those aged 50 and older,
according to congressional testimony weighing the Elder Justice
Act.
Provisions in the Elder Justice Act, which has been lolling in
Congress for many years, don't provide for elder abuse hot lines,
per se, but would create an Office of Elder Justice to establish
a "federal home" to provide funding for Adult Protective Services
agencies and their work, including awareness, training, detection,
prevention and prosecution of elder abuse.
"It's all about making people aware of what to do if they suspect
elder abuse, like who to report to," Blancato says, especially the
elderly themselves. He's optimistic that the act, which has no
stated opponents, could be passed soon.
"Elder abuse is a growing problem and the elderly are a growing
potent force," Blancato says. "The case can now be made that in
an intergenerational cycle of abuse, it's now the elderly's turn."
New Hampshire could use the dedicated funding that the Elder Justice
Act would provide to expand their phone intake capabilities. It
has an in-state toll-free number, which is routed to regional APS
offices during business hours. After-hours callers are advised to
call police.
For fiscal 2007, out of 2,451 calls, 1,633 were victims 60 and
over. More than half of those calls, 52 percent, concerned self-neglect,
says Lynn Koontz, APS administrator.
"We're committed to have older people stay in their homes as long
as possible, but they are more fragile," Koontz says. "It's a double
edge sword because the number of services they need are difficult
to provide and situations get more complex with family members.
Will we be able to maintain people at home safely without their
being prey to perpetrators?"
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