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By Thomas Goldsmith

When a doctor’s office, neighbor or relative reports mistreatment of an older person in North Carolina, the call to investigate rings at one of the 100 county departments of social services.

Counties pay more than four-fifths of the cost of looking into reports and finding solutions to those reports, with a federal social services block grant making up about 18 percent, and the state roughly .01 percent, according to the state Division of Aging and Adult Services.

Adult Protective Services Budget: FY 2017-18
County: $21,368,602  (82%)
Social Services Block Grant (federal): $4,846,003  (18%)
State: $1,474  (0.01%)
TOTAL: $26,216,078
Advocates for older people are mounting a push at the General Assembly this year for state government to take on responsibility beyond the training and monitoring it provides. At a Jan. 25 meeting of the North Carolina Coalition on Aging, Joyce Massey-Smith, director of the Division of Aging and Adult Services, presented the hard numbers on who’s paying the bills for adult protective services. Total spending on APS for the state fiscal year 2017-2018 was $26.2 million, with $21.36 million coming from counties, $4.84 million from the federal block grant and $1,474 from state coffers.

“The percentage of county expenditures for Adult Protective Services continues to outpace other funds; it is now up to 82 percent,” Massey-Smith said. “There are no [state] dollars specifically allocated to actually provide for protective services.”

North Carolina counties fielded more than 30,000 reports of mistreatment of vulnerable adults during the most recent fiscal year and substantiated nearly 3,700 of those. The rising numbers — nearly 10 percent more than the year before —  mirror the state’s swelling senior ranks.

In a December meeting, the North Carolina Coalition on Aging policy committee noted the burden on counties of paying for adult protective services, a state-mandated service that created “significant challenges in low-wealth counties.” Because of low funding, there’s high turnover in APS jobs and training resources are slim.

In the state budget, there’s one full-time social work planner/evaluator to work with county APS departments, but the position is also tasked with supporting the complex adult guardianship program. State legislators, not DHHS itself, have the opportunity to increase funding for adult protective services.

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“DHHS’ highest priority is protecting the health and safety of our most vulnerable adults and children,” the department said in a statement to NC Health News. “Both child and adult protective services are primarily supported through county resources, which leads to inequity in staffing and caseload levels across the state.

“The growing number of reports and substantiated cases suggests that additional funding is needed to adequately assess and respond to adult abuse and neglect.”

It’s the law

State statutes put the responsibility of adult protective services squarely on county governments. But large counties such as Mecklenburg and Wake have greater resources to handle burgeoning caseloads. Wake County is spending $2,793,952 on APS in the current budget year, said Craig Burrus, assistant division director for economic and social services in Wake County.

The Wake APS staff has a supervisor, seven senior practitioners, or social workers, and two temps.

“We’ve asked for two new positions,” Burrus said.

Counties are supposed to find services or help for victims of mistreatment that will keep the problem from happening again. In small counties such as Bertie, about two hours east and north of the Triangle, the social services department can simply run out of resources, even if staff are made aware that people need help because of abuse or exploitation.

State law says that county departments of social services must handle reports of older adults and those with disabilities who are abused, neglected or exploited. State DHHS lists ways in which the counties serve this vulnerable population.
  • Taking in reports and weighing information on whether APS should step in
  • Working with the person who may be abused as well as family and other caregivers to identify any abuse and to work to prevent it.
  • Turning over evidence of any abuse, neglect or exploitation to prosecutors and additional concerned agencies.
  • Taking the case to court if needed to protect the person.
  • Getting services underway to help the person.

Source: NC DHHS

“If we get a case like that and if that person doesn’t have Medicaid, we can send someone from our in-home care program, if there’s not a waiting list,” said Cindy Perry, director of social services in Bertie.

Reported APS cases in Bertie, with about 20,000 people, increased year over year from 54 to 61, or 13 percent. In the current budget year, the county has budgeted $11,519 specifically for Adult Protective Services and sometimes draws on other funds, such as the $18,909 set aside for in-home special assistance, if there’s any left.

“Our funds for aging are very limited,” Perry said.

“They stay alone”

As is the case across the state, most adults in Bertie subject to mistreatment are women and the most common condition is self-neglect.

“Especially a lot of our seniors, they stay alone,” Perry said. If more Bertie seniors could receive help with housekeeping and medications each day, she said, they would be more likely to remain out of the long-term care that typically costs the state much more than in-home care.

About 26 percent of North Carolinians 65 and older live at home alone, according to the Division of Aging and Adult Services. Most would prefer to stay there.

“There are not dollars for paying for medications that might keep me safe, and keep me protected … without having to face premature long-term care,” said the DAAS’ Massey-Smith, taking for a moment the role of a neglected older person.

“Obviously, long-term care in your adult care facilities and nursing homes are an important part of the continuum, but we are concerned about that premature step into that world.”

How common is substantiated abuse in NC?

During the state fiscal year that ended in June 2018, county departments of social services received 30,128 adult protective services reports.

About half were evaluated by a social worker to see if conditions in the report merited further action.
During the year, 3,682 reports were substantiated in North Carolina, not counting those resolved by other means after being evaluated.

Source: NC DHHS APS annual management report.

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Thomas Goldsmith

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...