A Day in the Life of

Adult ProtectiveServices

Prepared by County Welfare Directors Association of California,

What is “A Day in the Life of APS”? This project captured

and analyzed data about the reports APS received in California during a 24 hour period on March 5th 2004.

Project Design

Each of the 58 counties was given a spreadsheet to record all APS referrals received on March 5th:

Purpose of the Project:To “put a face on APS” by educating the reader about the:

1. types of clients who are at risk;

2. array of calls received; and

3. complexity of the issues involved.

Project Limitations This project does not

address: the results of the

investigation the case management

services offered or the end result of the

interventions.

Background Information APS in CA. is administered by 58 counties APS is a 24/7 program Definitions:

Elder=65 years and older Dependent adult= Any person between the ages of 18

and 64 (who) has physical or mental limitations that restrict his or her ability to carry out normal activities or to protect his or her rights, ..., including any person between the ages of 18 and 64 years who is admitted as an inpatient to a 24-hour health facility.

Background Information Types of abuse recognized in California

Abandonment Abduction Financial Abuse Isolation Mental Suffering Neglect Physical Abuse, including Sexual Abuse Self Neglect

Sample Vignette 211 The victim is an elderly woman with senile

dementia whose husband and sole caregiver had just committed suicide by shooting himself in their home. The victim was unable to care for herself. She did not know when to take her own medications and has no family in the area. Immediate response by APS was requested.

Sample Vignette 148 A 74 year old man was found by his

caregiver after being on the floor of the home for two to three days. The paramedics were called. The victim was dehydrated and transported to the hospital.

Sample Vignette 256 The 18 year old male victim is autistic,

developmentally disabled, and psychotic. His caretaker parents do not obtain needed medication or mental and physical health services for him. They also leave him alone with relatives who had abused him as a child.

Sample Vignette 61 While an 81 year old woman was

hospitalized for open heart surgery, her half brother got her to sign a power of attorney and a quit claim deed. He then sold her house without her knowledge or consent. The police are unwilling to press charges because of the power of attorney.

Gender of Elder Victims

Males 37%

Females 63%

Male/Female Ratio of Victims 65+

42%

CA Population

58%37%

Victim Population

63%

0%

10%

20%

30%

40%

50%

60%

70%

Male Female

Gender of Dependent Adults

Males 46%

Females 54%

Ratio of Elders to Dependent Adults

Dependent Adults 28%

Elders 72%

Victims with Cognitive Impairments

47%

23%

6%

19%5%

0%5%

10%15%

20%25%30%

35%40%

45%50%

No ImpairmentNoted

Demented

DevelopmentallyDelayed

Mentally Ill

Organic BrainInjury

Victims’ Ages

020406080

100120

18-19

20-24

25-34

35-44

45-54

55-59

60-64

65-74

75-84

84+

Ages of Victims

Num

ber o

f Rep

orts

Victims over 80

Age 80+ (37%)

Ages 18-79 (63%)

Comparison of reports to population

0%

5%

10%

15%

20%

25%

30%

35%

18-19 20-24 25-34 35-44 45-54 55-59 60-64 65-74 75-84 84+

Percentage of CA Abuse Reports U.S. Population

Victims with medical issues

64%

36%

0%

10%

20%

30%

40%

50%

60%

70%

Major Medical Issues No/Minor Medical Issues

All types of abuse

Assault/Battery Constraint/Deprivation

Sexual Assault Chemical Restraint

Over/Under Medication Neglect by Others

Financial Abandonment

Isolation Abduction

Psychological/Mental Self-Neglect

Assault 15%

Neglect 23%

Financial 17%Psych 14%

Self-neglect 26%

Self-neglectPhysical care 21%

Medical care 34%

Health and Safety Hazards 31%

Malnutrition/Dehydration 6%

Other (e.g. financial)

8%

Abuse by others

Financial Neglect Mental Suffering

Physical Isolation Abandonment

Abduction Sexual

Physical 20% Isolation 4%

Financial 24%

Neglect 31%Mental Suffering 19%

PerpetratorsCaregiver 16% Family 42%

Self 31%

Friends 3%Counselor 1%

Business 7%

ReportersReferral Source Number

Family Member/Relative 45

Hospital/Social Worker 38

Self 30

Case Manager/Social Worker 29

Friends and Neighbors 21

Home Health Agency/SW 19

Medical Personnel 18

Law Enforcement 15

Mental Health Personnel 13

Family Violence

Family Violence 22%Other Abuse

78%

Domestic Violence

18% 14%

68%

0%

10%

20%

30%

40%

50%

60%

70%

Male onFemale DV

Female onMale DV

Other FamilyViolence

Other findings 7 suicide related calls 10% of reports indicated the victim or

perpetrator had drug or alcohol issues. 6% were Regional Center clients.

Perspective on results This is only a snapshot- not the whole picture. This was a slow day for APS in California (Average =

352.4 reports per day vs 327 reports received March 5). Historically, California receives approximately 16% to

25% of the adult abuse reports nationwide. The National Elder Abuse Incidence Study 2, completed

in 1996, indicates that only 16% of all abuse is reported. If that percentage is correct, an additional 2000+ incidences of abuse occurred and went unreported in California alone on March 5, 2004.

Conclusions 37% of the abuse victims are 80+. 63% of the elderly victims are female. 64% of the victims have major medical issues. 53% of the victims are described as exhibiting

some degree of cognitive impairment. 26% of the victims of all types of abuse are self-

neglecting. If abused by others, 31% of victims are

experiencing neglect and 24% are reported as experiencing financial abuse.

Conclusions 42% of the alleged perpetrators are family

members. Family members and health care providers make

the majority of the calls to APS. The complexities of the abuse issues indicate that

the victims are likely to need interventions from more than one agency (e.g., mental health, law enforcement, in-home supportive services), reinforcing the importance of multidisciplinary teams in the treatment of adult abuse.

Next Steps

Further research Development of an “All-County” data collection

system More training for county APS staff and multi-

disciplinary team members Increased funding for these crucial programs is

needed Support for federal action to combat adult abuse