Queue is back for abused, vulnerable adults in Vermont

UPDATE: Since this story was published on Sunday, Aug. 7, Doug Racine, Secretary of the Agency of Human Services, has said he will fill all 10 permanent positions in the Adult Protective Services program and continue to use temporary employees to address the backlog of abuse, neglect and financial exploitation cases.

Jean Lemire went without food, drink or medication for six days. The 47-year-old developmentally disabled woman had hypothermia but was still alive when she was found in her caregiver’s home in Calais. She was later pronounced dead at Central Vermont Medical Center. Julie A. Davis, who received money from the state to take care of Lemire, went to prison for abuse and neglect of a vulnerable adult.

Last spring, Jodi LaClaire, a nursing home worker at the Thompson House Nursing Facility in Brattleboro, was charged with 16 counts of financial exploitation for racking up thousands of dollars worth of charges on a patient’s credit card over a 10-day period.

Robyn Page, a nurse’s assistant at The Lodge at Otter Creek in Middlebury, was convicted of stealing Oxycodone from an elderly patient last month. She replaced the pills with Tylenol.

These publicized cases of abuse of disabled and elderly Vermonters are rarities. Most incidents happen at home, cloaked in the kind of secrecy that mirrors domestic abuse. The perpetrators are often a member of an elderly person’s most intimate circle – a son or daughter, a parent, grandchild, caregiver or neighbor.

Abuse of elderly and disabled Vermonters is one of those issues no one — including victims — wants to talk about. The situations are humiliating, hurtful and confusing. And in some cases, the victims have dementia or are developmentally disabled and are unable to communicate information about what happened to them.

Because of confidentiality rules under statute, advocates and state officials are obliged to keep the stories of abuse under wraps, and the identities of the perpetrators and the details of the crimes are concealed to protect the privacy of the victims.

Thumbnail sketches of other painful scenarios give a glimpse of the nature of the problem. A grandmother who depends on her grandson for trips to the pharmacy and the grocery store is alarmed to discover the young man has racked up $30,000 worth of debt on her credit card. A woman who obtains durable power of attorney for her aged mother drains the bank account to buy things for herself and her children. A 21-year-old developmentally disabled woman is raped by a bus driver.

The scope of this kind of abuse in Vermont is making such stories more difficult to ignore. Incidents of illegal abuse, neglect or financial exploitation in the state are growing at an alarming rate, and state officials are scrambling to deal with the influx of complaints.

Between 2000 and 2010, the number of reports of abuse, neglect or financial exploitation of elderly and disabled adults doubled, and this year, the formal complaints – many of which are from human services professionals who are mandatory reporters – are expected to be more than triple the total number of complaints filed 11 years ago with the Department of Disabilities, Aging and Independent Living.

A running backlog has been growing for several years, and last fall the file of yet-to-be-investigated cases hit the near-300 mark.

In response to the threat of a lawsuit from two disability rights groups, the state agreed to hire more staff, change its protocols and bring the total number of pending investigations down to zero by Oct. 1. The department made significant progress in May, bringing the backlog down to just 79 cases, but the total popped back up to 261 by the end of June. Of that total, 44 have been pending investigation for more than six months. Most of these are financial exploitation cases. The Department of Disabilities, Aging and Independent Living has made an effort to address complaints of abuse and neglect within a 24 hour to 48 hour timeframe.

In addition to the cumulative number of cases the department must examine, employees of the Adult Protective Services program are struggling to keep up with the reports that come in the form of calls, emails and faxes at an average rate of 79 per week.

State officials say it’s unlikely that Adult Protective Services will finish the new and old pending investigations by the deadline set in an agreement with Vermont Legal Aid and Disability Rights Vermont.

Doug Racine, secretary of the Agency of Human Services, said he recognizes that the complaint backlog for Adult Protective Services is a serious issue, and his staff is dedicated to fixing the problems in the program as quickly as they can. Racine points to the budget cuts as a key factor for the backlog, but he doesn’t want to blame the previous administration and the Legislature.

“We’re not playing the game we’re perfect and they screwed it up,” Racine said. “When you go through budget cuts things can end up a little deficient.”

Racine said he is committed to making his agency as transparent as possible. He is dedicating internal resources to analyze the organizational infrastructure of Adult Protective Services. “I’m not going to pretend nothing is wrong,” he said. “But we’re on top of it.”

Ken Gordon, executive director of the Area Agencies on Aging, said abuse of elderly and disabled Vermonters should be treated with the same level of attention the state gives to the issue of child abuse.

He cited the mission of the Department of Disabilities, Aging and Independent Living as an ironic guidepost at the moment. The department’s mission “is to make Vermont the best state in which to grow old or to live with a disability ~ with dignity, respect and independence.”

“You can’t achieve that mission if there isn’t effective response to abuse, neglect and financial exploitation for older people and people with disabilities,” Gordon said. “This is one of those basic human need issues. If we can’t assure people’s basic safety, and we don’t have a mechanism for dealing with complaints, everything else is window dressing.”

State unlikely to meet deadline

Patrick Flood, deputy secretary of the Agency of Human Services, is conducting a top-to-bottom review of Adult Protective Services, including interviews with every employee of the program, and he will issue a report to his boss, Doug Racine, this week.

“I’d be surprised if we pulled it (the Oct. 1 deadline) off,” Flood said, given the current churn of employees in the program. (An employee left recently, and another staffer is set to leave by the end of the month.)

Flood is in the process of synthesizing the information he’s collected, but initially he attributes the dramatic upsurge in cases to organizational and staffing issues and possible problems with the data tracking system. It’s premature, he says, to attribute the increase in the number of complaints to the growing elderly population in Vermont.

“I’m not clear at all how to explain that (the influx in complaints) yet,” Flood said. “When you’ve got that kind of increase, you have to figure out what’s driving it. They (seniors) didn’t age that fast. My experience with these kinds of dilemmas is it’s never one thing – it’s always some confluence of events. … I want to know did we do something administratively that changed the numbers.”

Though advocates are disappointed that the state has not brought the backlog number down, they laud the department for its attempt to prioritize cases of physical abuse, neglect and financial exploitation. In February and March, Adult Protective Service personnel went through the backlog and called all of the contacts who filed reports of abuse address all “priority 1 or 2,” or abuse or neglect situations. Emergencies are now handled within 24 hours to 48 hours.

Ed Paquin, executive director of Disability Rights Vermont, one of the signatories on the corrective action agreement with the department, is cautiously optimistic, but he isn’t placing bets on an Oct. 1 turnaround.

“I think they’re trying very hard,” Paquin said. “But I think they’ve got a long way to go to get rid of that backlog.”

Unlike the eligibility benefits center backlog, which was resolved in a few months with adequate staffing and a new computer system, the Adult Protective Services backlog requires a lot of intensive research and investigation, advocates say. Michael Benvenuto of Vermont Legal Aid said they’re seeing a difference in the quantity and quality of the probes now under way, but pending investigations take more time to complete.

“Here you have to go out to visit seniors living in isolated communities,” Benvenuto said. “There’s a lot of legwork to do. We don’t want them to clear the backlog if they’re going to do it badly, we want them to do it properly.”

A history of underfunding

The department, which has undergone significant budget cuts over the last four years (about 16 percent of the workforce, or 50 positions, have been eliminated), hit a low point last fall when the number of active investigators fell to two.  In November 2007, there were eight social workers examining cases. (The job status for the position was changed from social worker to investigator in 2010.)

The commissioner of the department left in the summer of 2010, and then the head of Adult Protective Services was out on administrative leave for a number of months before she left altogether under a cloud. Employees were so overextended they couldn’t keep track of complaints and file legitimate reports to advocates.

Even before the program hit its nadir, retired commissioner of the Department of Disabilities, Aging and Independent Living, Joan Senecal, was so concerned about the welfare of her staff that she asked the Employee Assistance Program for help. Investigators were anxious and couldn’t sleep at night, she said, because they felt they couldn’t do a decent job, and they believed that they were leaving people unattended.

“People were developing medical problems, which they clearly would put to the stress they were under,” Senecal said.

Before newly elected Gov. Peter Shumlin was installed in office, he met with members of his transition team and the Douglas administration to talk about the troubling issues brewing at Adult Protective Services.

Several hundred reports of abuse, neglect and financial exploitation submitted by physicians, social workers, caregivers, family members, neighbors and advocates for elderly and disabled Vermonters had been relegated to the backlog, and there was no end in sight.

Shumlin and his team went into triage mode – they hired eight part-time retired Vermont State Police investigators, hoping that an influx of trained professionals would burn through the backlog quickly and bring the beleaguered program up to speed, but things didn’t go according to plan. The temps and the small group of permanent investigators started to bend the curve in February, March and April, but the backlog started to grow again by the end of May.

Susan Wehry, the new commissioner of the department, threw herself into figuring out the source of the backlog. She worked with advocates to come up with new protocols for prioritizing complaints, and she urged her team to substantiate more cases of abuse. (Vermont has been near the bottom of national rankings for substantiated cases for a number of years.) When the backlog numbers took a definite upward turn, she was “terribly disappointed.”

“Beginning in March, we began to make a big dent in getting more people on board,” Wehry said. “In March and May, I was feeling we were on track to systematically chip away at the backlog number. I had more confidence in the (prioritization) tool we were using. Even though numbers were growing, I felt no one was in real danger, so to speak.”

Wehry said staff turnover has been challenging. She plans to hire an outside consultant to help her figure out how to stabilize the program.

Though on paper it appears that the program has 17 active investigators, eight are part-time, temporary workers, who put in the equivalent of 200 hours per week. Caseloads in the past have ranged between 15 and 100 per person. The department has recently adopted an average caseload target of 25 cases per investigator.

Barbara Prine, an attorney with Vermont Legal Aid, said the program’s problems come down to inadequate funding. “They need to hire more people,” Prine said. “They can’t solve a permanent problem with part-time, temporary people.”

While Flood, deputy secretary of the agency, partially blames the data tracking system for the high number of cases the program is obliged to review, Senecal, the former commissioner of the department, said the data tracking system was accurate. She agreed with Prine: The problems the department faces always come down to resources.

Turnover is a given, Senecal says. “It’s a burnout kind of job. I would say people could manage it for a few years, and then it can become overwhelming.”

Temporary positions, in her view, are not a good solution. “Those people are constantly looking for work,” she said. “They need permanent jobs in this kind of economy.”

When asked if Senecal had enough people in the investigative unit during her tenure, she replied: “Never, never, never. We never had enough people to do the work that needed to be done.” At one point she calculated that the program needs about 15 investigators to “really do what needed to be done.”

Wehry is cautious about adding more staff. Advocates are convinced we need to expand the program, she said. “I as yet don’t have that opinion. I don’t know that we don’t and that we do. I think it’s really hard to say we need more investigators or that we have an ideal number in a system that continues to have this much churn in the investigative field.”

Vermont’s less-than-stellar track record

Ken Gordon, head of the AAA, says Vermont is an “outlier” on a number of issues related to elder abuse.

Though the department is making progress, advocates say the whole idea of a queue violates state statutes that mandate abuse prevention and relief for vulnerable adults.

Vermont has the slowest response time – 48 hours — in the country, according to advocates. In most states, investigations for abuse and neglect occur right away.

In addition, investigations take several months in Vermont to resolve, while the national average is 29 days.

People who want to report complaints after hours must call the child abuse hotline and wait for a response from Adult Protective Services the next day, or in the case of the weekend, as long as three days.

About 70 percent of the 3,000 to 4,000 complaints filed each year are reported by professionals — caregivers, medical personnel, social workers and law enforcement officials. These so-called “mandatory reporters” must file statements about abuse or civil penalties and fines. Of the 400 reports from home health and Area Agency on Aging case workers filed in 2009, only half were investigated by Adult Protective Services. That year, 8 percent of cases were substantiated.

“If trained professionals are making these reports, you’d expect more than a single digit to be substantiated,” Gordon said.

Compared with states across the country, Vermont has had among the lowest rates for “substantiation” for abuse complaints. In 2010, only 2 percent of cases were substantiated; over the last decade, the substantiation rate has been closer to 10 percent. The national average is 42 percent.

Wehry has made this issue a priority for the program, and so far about 36.5 percent of cases have been substantiated this year.

Editor’s note: This story was updated at 8 a.m. Aug. 8, 2011.