Magnifisyncopathological: Problems with Adult Protective Services

May 20, 2004

Problems with Adult Protective Services

Poor training, understaffing and organizational problems afflict Texas' elderly care program, which is under scrutiny for failing to remove clients from putrid, garbage-filled homes, according to a report released Wednesday.

The preliminary review, which examined 200 El Paso cases and Adult Protective Services policies statewide, found that a third of the case investigations were insufficient and that workers often failed to respond to severe cases by increasing contact with clients. In 71 percent of the cases where mental illness was identified or strongly suspected, workers did not attempt to determine mental capacity and proceeded as if the clients were competent.

And although the El Paso cases were the focus of the preliminary review by the Texas Health and Human Services Commission, it said the problems likely extend throughout the system.

The preliminary report is here for those who want the details. The Adult Protective Services (APS) program of the Department of Family and Protective Services (DFPS) is the program under review. APS is "...responsible for investigating abuse, neglect and exploitation of adults who are elderly or have disabilities." Expanded:

To protect older adults and persons with disabilities from abuse, neglect and exploitation by investigating and providing or arranging for services as necessary to alleviate or prevent further maltreatment.

Unsurprisingly, it has failed it's task. The El Paso-based study of 1,200 cases involving 200 clients is the first in a three-part series, but the information within is damning. Some findings from the report:

In 35 percent [of cases], the investigation did not fully address all allegations of abuse, neglect or exploitation.
In 32 percent [of cases], the caseworker did not obtain and document enough evidence to reach a conclusion.
In 41 percent [of cases], appropriate action to prevent further abuse, neglect or exploitation of the client was not taken.
In 35 percent [of cases], where there was a threat or a risk to the client's health or safety in the client's environment, the service plan did not address the threat.
In 44 percent of the 41 percent [of cases] where mental illness was identified, no steps were taken to address any special needs related to the mental illness.

I said I wasn't surprised with the results. This is because I know APS is a government program. Why does that matter? Because neither it, the DFPS, nor the Texas Health and Human Services Commission (HHSC) operate in order to be profitable or operate in the private realm where revenue and expenses determine whether you continue to exist or not.

Continuing from the Associated Press article:

"Preliminary findings confirm that serious deficiencies exist in virtually all aspects of the program," the review said. "These findings suggest that problems with the APS program may be fundamental and systemic."

The report says the El Paso office needs more staff, and repeats a previous recommendation that caseworkers be provided with handheld computers that can be used to instantly communicate with supervisors, including sending them photos of unacceptable living conditions.

"This preliminary review marks the first step in a process that I expect will remedy the serious problems that have plagued this program," Gov. Rick Perry, who ordered the review last month, said in a statement.

This is merely the rearrangement of the deck chairs on the Titanic. You can't solve these problems by reforming the program, the people working inside it, or the agencies controlling it. The report is correct in saying the problems are "basic system-wide deficiencies" but it doesn't acknowledge the source of those deficiencies: the fact that the state runs the damn thing. Without the fiscal discipline of having to attract customers, making enough money to cover costs, and competing with rival private programs on even grounds, taxpayer money will continue to be wasted and the people who should be benefiting will continue to get bad service.

With additional non-surprise, I learn that APS was the result of federal law:

The Adult Protective Services (APS) Program began in Texas in the mid-1970's with the passage of Title XX of the Social Security Act, which required that states receiving Title XX funds assure that the states' human services systems would protect children, elder adults and adults with disabilities from abuse, neglect and exploitation. During the 72nd Legislature, the Texas Department of Family and Protective Services (DFPS) was created, at which time the APS program was transferred under DFPS.

Never underestimate the folly of imposing rules and regulations from afar. On the other hand, the program's philosophy isn't all that bad:

Case resolution is client-focused, individualized, and based on a social work model of problem solving as opposed to a prosecutorial or law-enforcement approach.
The vulnerable adult is the primary client.

The client is presumed to be mentally competent.

The client participates in defining the problem(s) and deciding the most appropriate course of action.

The client exercises freedom of choice and the right to refuse services.

Service alternatives are the least restrictive possible.

In legal interventions, the client has a right to an attorney ad litum.

I'll always side with the options that restrict individual freedom the least, so this isn't so bad. Of course, the $30 million program budget doesn't come from people seeking help. It comes from coercing tax money from Texans. As a side note, I didn't know there was a $470 million-plus "Foster Care/Adoption Subsidy" in the Texas budget. *sigh*

The report continues to document other problems on the administrative side, problems familiar to anyone working in an organization, but problems that are less intense and solved faster and more efficiently when the organization isn't an organ of the state. Rampant bureaucracy can thrive when market forces are deliberately weakened.

From the AP:

In El Paso and around the state, elderly people have been left to live in homes without water or electricity and filled with animal and human excrement. Some of them moved out of the homes and were living in their cars through sweltering summers and freezing winters.

Adult Protective Services' policies have allowed caseworkers to walk away when an elderly person refuses services or successfully completes a five-question test to determine competency. The agency also has closed cases stating that filthy living conditions were "lifestyle choices."

Copyright 2004 The Associated Press. All rights reserved.

One more quote from the preliminary report and an indicator of worse things to come:

Policy favors an individual's ability to refuse services and does not provide appropriate or adequate guidance for intervention to prevent abuse, neglect, or exploitation. APS literature states: "APS philosophy, in most cases, is heavily weighted to client's liberty over safety. The fifth APS casework principle?asserts that freedom to choose is more important than safety." "An important principle of APS casework is that adults who have the capacity to make informed life decisions have the right to refuse protective services, even if they are in a state of abuse, neglect, or exploitation."
Emphasis on self-determination results in fewer court intervention requests to judges.

Since the general trend in government is towards more tyranny, more control, and more centralization, it would be a cuddly-safe bet to say the calls for more government intervention are needed will outweigh the calls for less.

Posted by Drizzten at May 20, 2004 09:44 AM

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Comments

Greetings:
There are some additional facts which may be useful. One is that, as I understand it, the formula by which Texas APS allocated money to the various regions was based on the number of cases closed. Some of the wizzards in management figured out that if they could open and close cases without any resolution, a number of good things could happen to their region. If workers did not get bogged down in actually helping anyone, they would increase the chances of new cases being opened up for the same individual again in the future. If they did not remove someone in distress, that person could in effect become a cash cow for that region. Actually, doing six cases on the same individual was better than doing six cases on different individuals because everything was known about the person who had been seen five times previosly. This appears to have been funding for failure. It appears APS saw its mandate as one of documenting the misery of human beings, writing up the reports needed for the file, closing the file, and waiting for the next referral.
In fairness, neither the State nor the National Governments provided much money to do more than investigate. Although, APS is housed in the same agency, Texas Department of Family and Protectives Services (FPS) as Children's Protective Services, APS is regarded within and outside FPS as a poor relative. Until recently workers in CPS were paid more for doing a comprable job than were workers in APS. More significantly, the federal taxpayer provides much more money for post investigative services for CPS than for APS. There is no or very little money available for anything in APS which would compare t the funding for CPS foster care.
If the system is merely going to collect and document data which demonstrates that people are living in filth with roaches, mice, rats, maggots and fleas as housemates as a matter of lifestyle, the arises, why do we need to maintain a $30 million a year bureaucracy? Why not cut out the middle man and leave folks alone and pocket the thirty million dollars? The answer is that most of these folks have spent a lifetime paying taxes, working hard, and being good citizens. I don't any of us would want to live like that and we would not want anyone we loved to live like that. There are at least two alternatives to the wasy we are currently doing busines which I believe would be more beneficial to vulnerable adults and to the taxpayer.
I believe one answer is in smaller, more locally based government. One can go anywhere in Texas and hear complaints about the way Childrens Protective Services fails children. There is another statewide agency which works with children, and that is Juvenile Probation Department (JPD). In truth, CPS and JPD often work with the same children and even more often work with the same families. Why, I ask, does the agency dealing with children who are perceived to be junior criminals have a better public image than the agency which deals with children who are perceived to be victims? I believe a major part of the answer is structure. The CPS program is run from Austin by folks who have little contact with the children they are supposed to protect or with the case workers who are actually trying to help the children. Much of the time and effort is directed to getting more money from the Legislature and developing new support positions. If a community is burdened with an incompetent administrator, there is little that can be done. There is little incentive for administrators to please the local community because raises, merit bonus plans, and desirable future appointments are in the hands of someone in state office.
JPD has a different structure. The chief executive lives and works in or near the same community as the child who is engaging in objectionable behavior. JPD is county or regionally based. The management is hired and fired by people who live in the local communities. The problem and those charged with dealing with the problem exist in close proximity. The opportunities for lobbying the Legislature are much reduced, and support positions are harder to come by. There is greater emphasis on results than on process, almost the opposite of CPS.
I recommend using JPD as a model for both APS and CPS with local officials charged with the hiring and firing of locally based workers and administrators. I suggest that State office be charged making sure that state and federal law and policy are followed, but the execution of law and policy be at the local level.
An alternative to the proposal above is privitization of protective services. In El Paso County, our guardianship program is funded by the county taxpayer, but it is done through a contract which is subject to periodic competitive bidding. We have gone through a learning process, but we are developing an approach which is driven by the market rather than by politics. There have been bumps in the road and problems, but I believe that the market provides benefits in terms of customer and taxpayer satisfaction which will never be available through the government and/or political processes. In El Paso, our unit costs for guardianship have decreased over the last several years and I expect our approach will demonstrate even more effective and efficient results.
I believe that protective services may lend themselves to contracting with increased benefits to those who require protection and those who pay for the protection.
Perhaps I am completely wrong in my analysis and I welcome dissenting views because I think it is in open discussion and competition the best will be made available. I hope our host does not consider me "some psycho idiot jerk" and that I will be allowed further comment when I see the need. I do thank our host and you for reading this.

Posted by: Max on June 5, 2004 11:14 AM

Max, as your host, I don't consider you a "psycho idiot jerk." :)

The first 2/3 of your comment is indicative of what I mentioned before: it's a rearrangement of the deck chairs on the Titanic. There certainly are benefits of structuring a bureaucracy one way over another and I won't dispute that here; you apparently have a firmer grasp of the details of each agency.

What I will dispute is your assertion that "[t]he answer is that most of these folks have spent a lifetime paying taxes, working hard, and being good citizens. I don't any of us would want to live like that and we would not want anyone we loved to live like that."

No, I would never want to live in the awful conditions described, nor do I want any innocents stuck in the same. But that desire to see people live in health, cleanliness, and safety doesn't mean we should make the government take money from you, me, and other Texans and distribute it towards those in need. Being a taxpayer doesn't grant you the right to ask for the state to provide for your needs.

Beyond the fact that any sort of government redistribution is inherently wasteful above and beyond a legitimate private entity aiming for the same outcome, I shouldn't be compelled to be charitable. You especially shouldn't have to subsidize the living conditions of an untold number of people whom are directly responsible for ending up as they are today by not making good decisions and saving for their future.

In any case, thanks for the structural comparison between the CPS and the JPD.

Posted by: Drizz on June 9, 2004 04:02 PM

El Paso Adult Protective Services is a scandalous agency that is ripping off the elderly. Perhaps APS should keep in mind who it is that they are trying to help. The elderly. I have become aware of specific recent cases whereby APS is abusing a situation by coersion and denying the rights of the individual victim. There has been a great deal of missapropriations of money by the court appointed guardian which is clearly illegal and wrong. The court appointed guardian has also involved his family in the personal matters of the elderly individual he should be helping. This is a clear violation of privacy. How can court appointed guardians have their family assist them in researching and going through a elderly individuals posessions? How can families protect themselves from the very agency that is supposed to be helping them? It is a sad day when situations like this arise. May God help Adult Protective Services to remove the people abusing not only their power but the very individuals they claim they seek to help. What a hippocracy. What a mockery of an agency that should be there to protect the needs of the elderly.

Posted by: E Rodriguez on July 7, 2004 01:53 AM

I found your message quite fascinating. Could you give me specifics in relation to your view of APS (Adult Protectivre Services, in Texas). I am doing a study of the foul ups of APS if you know of anyone else that has had a negative contact with APS please help nme contact them.
Thanks, Jim depjim@eastex.net
I found your message at the URL below.
http://www.drizzten.com/blargchives/000843.html

Posted by: Jim Watts on October 22, 2004 12:42 PM

I have experience with both of the government bodies you mention. The biggest flaw as far as I am concerned is the fact that they can work in complete secrecy. I tried to help my grandmother at nursing home in Bryan and learned more that I wanted to know about those places.
I learned that there is information given to those homes by workers in the agency and that they cover for each other. The nursing home industry in Texas is like organized crime.
The CPS is even worse, because they appear to answer to no one. The office in Dallas is nasty and dirty and this was where I observed them allowing families to visit with their children.
The drama was intense.
The staff does not dress or groom themselves in a professional way, and are under trained or they just make things and rules up as they go along. I recommend the people only talk to CPS with a tape recorder running at all times. They change their stories as the day progresses. When they are questioned, they say that you are mistaken. I say they lie.
Thanks and good luck to anyone who needs help for a child or a grandparent in need of protection in the state of Texas.
Family Protection Services should renamed themselves like Prince and it should be a name that cannot be spoken. That way we would never call them.

Posted by: Donna Binks on March 5, 2005 10:43 PM

back to my hometown el paso,with my elderly parents and disabled child for the past 7 months. just read your article. you are 'dead on'. turns out my 'holier than thou' nephew, bruce yetter represents DPS. well let me tell you, i ain't even started, and i got a big 'new york city' mouth and attitude.anyhow, i am glad u have a place where i can vent.

Posted by: victor gutierrez on April 16, 2005 01:02 AM

Am looking for Indiana cases to do videos about the abuse in cps and aps
bif
afra

Posted by: bif Guenthen on July 30, 2005 09:33 AM