old man with a walker on a lakeshore
Photo credit: bluesbby, Flickr Creative Commons


There are more seniors who have no one to look in on them when things go wrong. How should the state respond to them?

By Thomas Goldsmith

“‘There’s a woman on our block,’ the caller says, ‘who’s 80 years old and has quit going to the doctor. She’s hoarding, she’s not taking her meds and can’t move around well enough to care of herself or make her own meals.’ ”

That’s how Lee Little, a supervisor in Durham County Social Services, describes the kinds of reports that come into Adult Protective Services from neighbors, friends or any concerned party.

old man with a walker on a lakeshore
Photo credit: bluesbby, Flickr Creative Commons

When neglect or abuse puts an older person in North Carolina in harm’s way, the duty to assess this type of report goes to the staff at each county’s adult protective services division. A home visit can produce results ranging from the provision of a home-health worker to a person being placed under county-appointed guardianship.

In an aging North Carolina, the numbers of people in guardianship is on the increase — up 20 percent annually in Wake County. In response, the state Department of Health and Human Services is gathering comments on how well older people and those with disabilities are served by North Carolina’s system of adult protective services and adult guardianship.

“The input from these listening sessions will inform the work of DHHS for the next several years in addressing the growing number of Adult Protective Services reports” the state said in a release. The statement said DHHS is making “efforts to ensure the least restrictive alternatives are made available when adults need surrogate decision makers or other alternatives to guardianship.”

Sessions will be held in counties filled in with red. Click on the county to find the date and time.

If you would like to attend a session, please contact Joyce Massey-Smith, Adult Services Section Chief at the Division of Aging and Adult Services, at joyce.massey-smith@dhhs.nc.gov or (919) 855-3401 and she will provide you with additional details.

Assessing, offering help.

The $4.4 million program deals with cases of abuse, caretaker neglect, self-neglect and/or exploitation of consumers. The process begins with a report — it can be from anyone — and proceeds with an unannounced home visit to assess conditions.

Staff members are required to keep the wishes of the client at the fore during the visit.

“When you get through your evaluation, the last thing you are supposed to consider is does the person have the capacity to consent?” said Craig Burrus, Wake County program manager of senior and adult services. “If they do, they can decline anything we might offer them.”

If a client refuses help, Adult Protective Services staff can evaluate whether to petition the county Clerk of Court for guardianship. That means the county would take responsibility for personal and financial matters for a client who can no longer care for herself.

County officials added four new contract positions for guardianship in Wake County in the budget year that began July 1.

“We have about 520 cases that we are handling in-house and another 273 that we contract out,” Burrus said. “That’s twice as many as Mecklenburg.”

Services undergo change

In the past few decades, families have become more fractured. Older relatives are less likely to have nearby support systems in place, said Durham County’s Lee Little.

“Circumstances have changed; adult children are living farther away than they were 20 or 30 years ago,” he said. “Kids are all over the country and even overseas. They are not able to provide that service.”

A resident walks in the hallway of Wake Assisted Living in Raleigh.
A resident walks in the hallway of an assisted living center in Raleigh. Photo credit: Rose Hoban

The heart of APS’ work is to provide protection, Little said. “A facility placement is the last resort.”

When people under county guardianship are placed in long-term care, it’s APS’ job to pass along their Medicaid, Social Security or SSI payments to a facility.

One means to avoid the need for public guardianship — and a likely topic at the state listening sessions — is the use of advance directives so that a person who is likely to become vulnerable already has a guardian or decision maker named.

That’s not always possible among the APS client base.

“The people that end up in guardianship often don’t have that kind of person available to them,” Burrus said. “Outside of the people that we serve, those are good ideas.”

Across the state, listening

The series of “listening sessions” that last until the end of September won’t likely be gathering dust on someone’s shelf. Previous tours have led to changes in foster care and other areas. DHHS took input from communities across the state in 2015 before completing an amendment that went into effect in January to the N.C. Innovations Medicaid Waiver for people with intellectual and/or developmental disabilities (I/DD).

Durham DSS officials will take part in Tuesday’s meeting, along with state DHHS leaders Sherry Bradsher, deputy secretary for human services, and Suzanne Merrill, director of the state Division of Aging and Adult Services.

Across the state, 11 host county departments of social services have invited local stakeholders, including advocates, to present “challenges they face on a daily basis to meet the needs of vulnerable adults, along with opportunities that could be explored to improve and enhance the efficiency of services.”

Discussion themes include community collaboration, data accessibility, housing placement, mental health, multidisciplinary evaluations, statutory changes, substance use and workforce opportunities.


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Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...