photo shows an elderly woman in a dress and cardigan looking out a window covered by a lace curtain
Adult Protective Services staff regularly check on the seniors in their community to protect adults with disabilities from abuse and neglect. COVID-19 has made that job much more difficult. Credit: Chalmers Butterfield

By Thomas Goldsmith

Sharnese Ransom works to protect adults with disabilities from neglect and abuse, both in her Raleigh neighborhood and when running the statewide group that represents North Carolina’s frontline troops against abuse of aging adults.

The 2020 arrival of the pandemic has made it tougher on both settings. In fact, the state’s most influential groups on aging issues are pressuring Gov. Roy Cooper to include $7 million for Adult Protective Services in his budget for the fiscal year starting July 1.

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But that’s five months away. Right now, the pandemic is a menacing presence in neighborhoods like Ransom’s, where informal community concerns about vulnerable people often arise. It’s harder for that information to reach APS when there’s a pervasive fear among older people about contracting COVID-19.

“What I see is people afraid to get the virus and they stay so isolated,” Ransom, executive director of the North Carolina Association of County Directors of Social Services, said in a recent phone interview.

“There’s just a lot of self-neglect occurring out there,” she said. “In my neighborhood, I know where seniors live, I’m always going to their door, putting a note on the door: ‘Hey, this is Sharnese again. Do you need anything? Give me a call!’”

Her organization is in good company in pressing for more state funding in light of longstanding needs and the impact of COVID. Other advocates include the Governor’s Advisory Council on Aging, the NC Partnership to Address Adult Abuse, NC Senior Tar Heel Legislature, AARP NC, Friends of Residents in Long-Term Care, and the NC Coalition on Aging.

Calling on Cooper

“Rising caseloads demand greater funding so that staff may spend adequate time with clients and investigate abuse, neglect and exploitation complaints,” Roger Manus, chair of the Governor’s Advisory Council on Aging, wrote Gov. Roy Cooper in January. “The lack of adequate pay and impossible caseloads contribute to high turnover rates among APS staff.”

In North Carolina counties, social services officials have seen the pandemic as increasingly cutting into the statutory right of people with disabilities and older adults to be free from abuse and neglect. In 2020, APS offices also faced practical shortcomings posed by COVID-19, as well as in state funding.

“In smaller counties, they need more dollars for staff and services,” said Craig Burrus, assistant division director for adult and family service at Wake County’s Human Services operation. “I’m sure there’s more stress on them to have the things they needed because of COVID.”

Adult Protective Services represents one of the small, but vital, government operations that compete at the start of every General Assembly session for more money, ideally for a recurring boost. Their competition for a bump amid a multi-billion state budget can have real-life fallout, especially in small counties.

At the face-to-face level of social services, some COVID-wary staffers in Greene County have shied away from making in-person visits in order to deal with complaints and violations, Angela C. Ellis, director of county social services, said in a phone interview. Some clients and caregivers worry that investigators themselves will bring infection into homes as they try to meet increasing demand and handle more complex cases.

“We did see an increase in APS complaints,” Ellis said of the pandemic presence in Greene County. “They were very intense cases and that put the strain on workers. We’d have cases where you’re already dealing with mental health issues and then you have to add on physical abuse and financial exploitation.

“A lot of workers were burned out.”

Once a victim of abuse or neglect is located and stabilized, counties can use home health workers to check on his or her progress, but that can also stretch slim county budgets.

It’s the law

Across the state, Adult Protective Services is legally mandated to take reports on neglect or abuse of people with disabilities and older adults — whether physical, mental or financial. The service is then required to take action, with their own staffs, using county, federal and community resources.

Advocates say a persistent and structural problem for APS lies in the state’s failure to pay more than about one percent of the service’s cost, effectively demanding that counties use their own cash along with using federal grants to fulfill a state-mandated service.

State budget writers for the House included $893,041 for APS in both years of the 2019-2020 budget, but the increase for APS was drawn from a federal trust fund, not from any additional state allotment and not recurring for coming years.

When it comes to getting money from the legislature, agencies look for those recurring dollars before hiring new staff or starting new initiatives. It’s hard to hire staff, for example, when the dollars are only guaranteed for a year or two.

“Funding from this source and from state sources recommended above should be recurring in order to afford the stability necessary for stakeholders to have the confidence to make the necessary reforms which would meaningfully protect senior North Carolinians,” Governor’s Advisory Council on Aging members wrote Cooper recently.

More than 30,000 complaints and reports poured in statewide in 2020 to APS offices. Those employees were meeting COVID-related demands such as having to schedule additional time to protect their own health and to meet clients and caregivers safely. They also had to compete with other county departments for funding, staff hours and personal protective equipment, or PPE. The federal CARES Act provided some much-needed funds, but other dollars that usually come from nonprofits, churches and contractors dried up in the pandemic, county social services directors said.

Managers also had to protect the health of their workers and the stability of their workplaces as they went about their rounds.

“We still have to continue to go out into the homes and the facilities,” Cindy Perry, director of Social Services in Bertie County, said on the phone. “But we try to keep our staff out of the facilities as much as possible.”

Many cases go unreported

Neglect, abuse and fraud targeting older people can lurk beneath the reluctance of victims and caregivers to turn abusers in — whether because of shame or lack of the follow through on a complaint. The effects are stark, according to the current aging plan from the Eastern Carolina Council Area Agency on Aging.

“The effects of abuse are devastating on our older adults. Abuse results in increased rates of depression, mental health issues, and increased mortality rates,” the plan’s authors say. “Older adults that are victims of abuse are more likely to be admitted into long-term care facilities and are twice as likely to be hospitalized.”

Scammers of older and disabled people are too often relatives and close acquaintances. It’s not uncommon for them to have absconded with savings squirreled away for victims’ retirement years. When that money is gone, poverty can result.

On top of other COVID-19 concerns, Perry and others have had to deal with an increase in scam attacks on older people. In a low-life ploy often pulled on people with dementia, criminals may call posing as a relative or other trustworthy person who wanted money sent to them in another country. (A tip: Don’t do it.)

Feeling the weight of COVID fears, policies

People who first encounter instances of such cold-blooded crimes should be aware: When these criminals go low, they go really low.

These days, law enforcement principals say scammers are raking in money by fraudulently charging for spots on a non-existent list for a COVID vaccine shot. In an AARP alert, Tom Miller, Iowa’s attorney general, says that some scammers even offer older people  “tickets” that supposedly secure a waitlist spot for a vaccination.

Meanwhile, a raft of new policies designed to slow the pandemic’s spread has further complicated APS issues. For example, stay-at-home rules set by Gov. Roy Cooper meant that people facing neglect and abuse were far less likely to attend church or visit other community spaces where they might receive help or tips in facing the very disease that keeps them at home.

The isolation engendered by COVID can keep news of outbreaks and individual cases from reaching APS through informal channels. Suspected neglect or abuse is less likely to be reported to APS by a relative, acquaintance, law enforcement officer, banker, doctor or lawyer because those encounters have gone away.

“This is something that we all have a stake in and that we all should be supportive of,” Harold Barnette, chair of the North Carolina Coalition on Aging committee on health and equity, said at a recent meeting.  “As this epidemic demonstrates, a vulnerable group can be a vector for infection and spread to everybody in society.”

APS problems widespread

Even though the COVID threat is relatively recent, counties have long faced specific requirements from the state Department of Health and Human Services to treat abuse and neglect cases in a timely manner.

“Responding quickly to allegations of adult maltreatment is essential to case decision-making to protect the adult,” reads the 2019-2020 budget for Bertie County, quoting general statutes on counties’ duty. “State law requires that a prompt and thorough evaluation is made of all reports of adult maltreatment.”

DHHS expects counties to respond immediately when receiving complaints of an emergency that could cause death, within 24 hours if the complaint says there’s danger of irreparable harm to the victim, and within three days if the complaint doesn’t say there’s danger of death or irreparable harm.

Concerns about APS during the pandemic extend far from North Carolina, as seen in a report by the National Adult Protective Services Association.

“During this time, mandated reporters of abuse such as in-home care workers, medical providers and bank personnel are not available to observe and report suspected maltreatment to Adult Protective Services, the first line responders to maltreatment of older persons and younger adults with disabilities,” the report said.

“Also, many families are experiencing extreme emotional and financial stress which too may increase the risk of neglect or financial abuse.”

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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...