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Andrew M. Cuomo, Governor
Sheila J. Poole, Acting Commissioner
March 2018
Volume 10, Number 1

The Adult Services Newsletter

Message From the Executive Office
 
2017 NYS AATI Conference Highlights Issues of Social Isolation
 

By acting OCFS Commissioner Sheila Poole

   More than 320 people attended the 24th annual New York State Adult Abuse Training Institute (AATI) November 1-3 in Albany. The conference theme, Social Isolation: Our Clients & Our Work, was reflected in the keynote address by Holly Ramsey-Klawsnik, Ph.D., titled “The Role and Relationship of Social Isolation to Self-Neglect.” Dr. Klawsnik is a clinician and the director of research for the National Adult Protective Services Association.


   Two other plenary speakers were Alan Teel, M.D., director of Full Circle America and co-founder of ElderCare Network, and Linda Tetor, Executive Director of Steuben Senior Services Fund, who discussed ways to combat loneliness and its devastating outcomes among older individuals. Workshop tracks included social isolation, financial exploitation, law enforcement and domestic violence. The conference also featured the Upstate New York premiere of a short film called Assisted Living, written and directed by Dan Hunt, addressing ageism, family dynamics, and financial exploitation by family members.
   Thanks to the Bureau of Adult Services who, together with the Bureau of Training, the Brookdale Center for Healthy Aging, and an energetic interagency conference planning committee, organized and presented this valuable conference. I look forward to next year’s silver anniversary AATI now in the planning phase.

Above: Holly Ramsey-Klawsnik, Ph. D.; below left: Ternesia Calhoun, Queens APS deputy director and Kenya Edward, APS caseworker at Queens Human Resources Administration at the "Speak Now Or Forever Wish You Did" workshop; below riight: plenary speakers Linda Tetor and Alan Teel, M.D. 

 

 

 

 

 

 

 

                                                                                                                  

 

Walking the Tightrope: Challenges and Successes in Working With “Self-Neglect” Cases
By Bureau of Adult Services Director Alan Lawitz

   If you don’t work in Adult Protective Services, you probably do not know that the majority of APS referrals are “self-neglect” cases. These are cases in which the danger to an adult with impairments is due to an inability to care for or protect oneself from harm, rather than due to the action or inaction of another person.

 

                                                                                Bureau of Adult Services Director Alan Lawitz

   In 2017, self-neglect referrals outside of New York City comprised over 69% of all APS referrals for adults age 18 and older, and 65% for ages 60 and older. In New York City, 66% of all APS referrals for ages 18 and older were self-neglect, and 65% for ages 60 and older. Federal data released in August by the U.S. Administration for Community Living (ACL) under the new National Adult Maltreatment Reporting System states that of the 43 states, District of Columbia and territories that submitted data on maltreatment types, self-neglect comprised the highest percentage of victims (57.7%), much higher than the next-highest categories of risk, neglect (19%), financial exploitation (15.9%) or emotional abuse (14%).
   I recently invited APS supervisors to share their thoughts with me on what they see as the most challenging aspects of self-neglect cases and what approaches are most successful in addressing those challenges. I received a number of thoughtful responses. Here are a few:

Karen Glover, Fulton County:

   Many of the self-neglect cases we see involve people who have lived this lifestyle for many years. Some of them may not understand that they are not taking care of themselves and that making some changes would improve their quality of life, so they can continue to live in the community. Explaining things can be difficult, as we do not want to embarrass the person or take their dignity away. Being able to engage the person, by having frequent contact with them and building a trusting relationship, can help with getting people to make small changes. Approaching the situation in a non-threatening manner is helpful. We try and ask the person what their plan is and give them a role in making the changes. Asking for client’s input/opinions, not being judgmental and explaining that we want to keep them safe and in the community. Letting the person know and showing them we will advocate for them as well. Assessing their capacity to understand and determining if their lifestyle is putting them at risk of harm or death.

Jodie Smith, Washington County:
   The most challenging aspects are determining whether a person lacks capacity and determining the level of capacity. Not all of our clients will see a physician. Plus, we lack resources in our area. People are able to make choices about some of their needs but not in all areas. For example, a person may be able to meet their need for food, clothing and shelter but may not be able to maintain their finances.
   There is a lack of training about dementia or dementia-related illnesses. Many people here see dementia as a diagnosis and automatically assume a person lacks capacity. We know this is not the case in all situations. People may suffer from dementia but have the capacity to make their own choices and decisions.
   People make bad choices in general but choose to do so. They still have the capacity but do not want to change their behaviors. People oppose any type of assistance. They do not want to work with anyone. People are afraid to change. We tend to get many calls on these cases, sometimes over-and-over again.
   The approaches that have been most successful in addressing these challenges are engagement; building trust and rapport, which can take a very long time before anyone will start making changes.
   In Washington County we have an Aging and Disability Resource Center. We are more involved with the delivery of services and can talk more in depth about the services available to them. APS wears more than one hat and works very closely with other services and can offer those services more quickly at times.

Suzanne Bloes, Chenango County:
   We are getting many cases of younger adults who have personality disorder diagnoses who tend not to be eligible for programs such as supportive housing because the eligibility criterion appears to be “severe, persistent mental illness.” Many of these folks have very little insight into the reasons for their failure to be self-supporting and have trouble complying with requirements for cash assistance, for example. We generally try to find informal resources but with some these have been exhausted. What we are seeing are persons with developmental disability with lower intellectual functioning, but who are not eligible for OPWDD services. These people tend to be functional enough to be nominally self-directing but persist in making very poor choices.
   For more elderly clients, we tend to monitor even if there isn’t an active APS case, only because we are a small county and can manage to do so. Quite often these people persist in wanting to stay in their homes even when these become marginal at best. We have at times had some success with code enforcement posting homes, but in at least one instance the person refused to leave and continues to live in the house. She has capacity but we regularly see her and try to have someone from our Mobile Crisis Assessment Team go out with the caseworker so we can check on decline with a clinically-trained person.

Robin Rafan, Chautauqua County:
   Most challenging are alcoholism, organic vs. mental health; they have capacity yet are unsafe (how long do you monitor).
Our most successful approaches include monitoring these cases to build relationship with client and wait for opportunities to effect change.
   Thanks to these and other APS supervisors who responded. These responses illustrate the difficult work APS workers perform, having the dual responsibility of protecting safety and protecting the rights of persons with capacity to make choices, even poor choices. Let’s all take a moment to thank those who daily walk this tightrope.

 

1,273 Days
By Supervisor Emily Burns, Adult and Family Services,
Broome County Department of Social Services

   On February 14, 2014, Broome County Adult Protective Services received a referral regarding a 74-year-old woman, LR (not her real initials), who appeared confused and was wandering her trailer park dressed inappropriately for the weather. We knew little about LR, but were aware of a friend who acted as her caregiver with whom we had interacted several months prior.
APS caseworkers responded to the home and found LR confused and deferring completely to her caregiver. APS contacted CASA for an assessment and reached out to the caregiver to ensure immediate needs were met. A second home visit revealed that LR was locked in her trailer, talking to a bottle cap and unable to open her door. Through the door, LR agreed to have police come to the home to gain entry. While one APS worker contacted the New York State Police, another called the Broome County Mental Health Department to obtain an order to have LR transported to a local emergency department for evaluation.
When LR finally emerged from her trailer, it was clear that she was profoundly confused, as she was unable to tell workers her name or date of birth. A thorough review of our agency records revealed that LR was a former New York State employee and a former foster parent in Broome County.
   While APS workers attended to LR at the emergency room, police followed-up with the caregiver. The trooper who worked the case called APS and was concerned that something more was going on, as the caregiver had possession of LR’s checkbook and her car. The trooper agreed that the case would be passed on to investigators for additional follow-up. Meanwhile, APS began checking public records for more information on LR.
   The check of public records led us to contact a local credit union. The credit union was unsure what information it could release but offered that there appeared to be numerous questionable transactions. The credit union agreed to review LR’s accounts and contact APS the next day to make a referral if necessary. APS provided the credit union with the legal and regulatory citations that allowed them to release information we needed.
   The next day, it was learned that LR was dehydrated and malnourished. She was suffering moderate to severe dementia and was admitted to the hospital. APS requested that our legal department file an Article 81 guardianship petition. A family member was located outside the county and agreed to meet APS and state police investigators at LR’s trailer so that it could be observed and some of her personal belongings could be collected.
   LR’s home was found to be in a horrible, unlivable condition. There was no running water, no food, piled garbage (inside and outside), feces in the toilet, no appliances; there was no question that the caregiver was doing little to help LR live safely, comfortably or with any measure of dignity.
   The credit union eventually called and offered years of bank statements detailing checks written out to the caregiver in the amount of tens of thousands of dollars. There was also evidence that LR’s funds were being used to pay utility bills at addresses other than her own. All this information was turned over to the state police for criminal investigation.
   The commissioner of the Broome County Department of Social Services was appointed as guardian of LR and her property; LR was safely placed in a skilled nursing facility. Unfortunately, the Chronic Care Medicaid application proved difficult, as there transactions amounting to thousands of dollars that could not be accounted for. LR was hit with a penalty of almost $30,000. An appeal was filed and eventually won, as it was clear she was a victim of financial exploitation.
   And we waited. Six months after the initial referral, LR’s caregiver was arrested and charged with grand larceny and endangering the welfare of a person who lacks capacity. And we waited some more. Nearly a year after it all started, LR’s caregiver was indicted on grand larceny charges. Another year went by and APS learned that a special prosecutor had to be appointed because the perpetrator, Garo Kachadourian, was a well-known community member who had at some point run for mayor.
   Several months later, a bench trial was held where APS workers were among those providing testimony. Garo Kachadourian was convicted of grand larceny. And we waited through more legal wrangling. Finally, on August 9, 2017, Garo Kachadourian was sentenced for his crime; he was ordered to serve four weekends on a Broome County Jail work crew, to be under probation supervision for five years and to pay LR $13,000 in restitution. He made restitution immediately.
   It took five adult protective services staff, state troopers and investigators, a bank manager, multiple medical personnel, two DSS attorneys, two criminal prosecutors, two judges and 1,273 days to get justice for LR – and it was worth every second.
   There is no doubt that justice for LR was the direct result of the cooperative efforts of many, many members of our community – it was exactly what APS is supposed to be: a community response. Every professional who was involved with this case was necessary for its success. As the APS unit supervisor, it was heartening to see my staff support one another and work cooperatively with our community partners for a common goal. This case was a first for Broome County APS and we celebrated!
   Editor’s note: Congratulations to Broome County APS and its partners: the New York State Police, the credit union, the district attorney’s office, and others who contributed to this hard-earned success story!

Training for Financial Institutions Held in White Plains
    On December 6, 2017, OCFS and the NYS Department of Financial Services (DFS) co-sponsored a multidisciplinary training of financial professionals, one in a series of such trainings being conducted around the state. The purpose of the training is to assist managers and other staff of banks, credit unions and brokers to recognize, prevent and report suspected financial exploitation of elderly and disabled adults. The presenters in the photo below are, L-R: Kerri Tavzel, elder abuse coordinator, Family Services of Westchester; Bruce Wells, associate counsel, NYS Department of Financial Services; Jean Park, APS supervisor, Westchester County DSS; Alan Lawitz, director of the OCFS Bureau of Adult Services; Paula Sternberg, assistant counsel, NYS Department of Financial Services; and Frederic Green, second deputy district attorney, Westchester County Office of the District Attorney.

 

 

 

 

 

Above left, L-R: From Washington County, Gina Cantanucci-Michell, executive director of the Office for the Aging and Disabilities Resource Center; Jenna Abrahamson, social services examiner; Andrew “Jock” Williamson, senior APS caseworker.

 

Center: Richard Downs, deputy chief of policy, Greene Police Department, presents “Physiological Response of Truthful & Deceptive Persons."

 

Right: Gary Brown, Esq., statewide elder abuse coordinator in the NYS Office of the Attorney General, discusses recognizing and preventing frauds and scams that target older adults.

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Below left: John Nowinski, EMT-P, injury prevention coordinator/EMS liaison at Orange Regional Medical Center, presenting on preventing falls

 

Center, L-R: Lisa Rachmuth, (NYCHRA) and Linda Drummond Johnson (Brookdale Center for Healthy Aging), presenting on intergenerational aspects of family violence

 

Right: Amanda Leis, Money Management Program consultant, presenting at a workshop called “Early Dementia In Isolated Older Adults – A Window For Intervention”