Local Matters
Increasing numbers of old, frail and disabled Vermonters are falling victim to abuse, neglect and exploitation — and the state agency charged with protecting them is so understaffed and overworked that it’s just a matter of time before the media will be reporting “horror stories” about it.
That’s the dire assessment from a loose coalition of advocates who work with Vermont’s “vulnerable adults,” a legal term that encompasses anyone 18 or older who is elderly, infirm, mentally or physically impaired and receiving state assistance, such as residents of nursing homes and assisted-living facilities.
In the last year, complaints of abuse, neglect and exploitation of vulnerable adults filed with the Department of Disabilities, Aging and Independent Living (DAIL) increased 48 percent. That coincided with a 17 percent reduction in the department’s staffing, from 316 employees a year ago to 261 today.
Why the huge spike in abuse reports?
DAIL Commissioner Joan Senecal suggests one reason may be that more Vermont families are feeling the pain of the economic downturn. Another major area of concern, she says, is the explosion in prescription drug diversion. State investigators are reporting sharp rises in the number of family members and caregivers who are stealing pain meds from their elderly and sick wards.
Advocates claim that DAIL’s ability to respond to specific allegations of abuse, neglect and exploitation has been so compromised that the state is now “triaging” calls based on their severity and investigating only a small fraction of the total complaints received. Some of the department’s caseworkers are taking on double, and sometimes triple, the recommended caseload.
“I liken the current situation to the Champlain Bridge,” says Dolly Fleming, executive director of COVE — Community of Vermont Elders — a nonprofit group that advocates for the safety, welfare and dignity of Vermont’s population of senior citizens. “If you look underwater you see that the foundation of the state’s public structure to protect vulnerable, abused and neglected adults is crumbling.”
Fleming was among a group of advocates who attended a June 11 meeting of the DAIL Advisory Board. She and others were deeply alarmed by the agency’s own assessment of its diminished capacity to protect those Vermonters least able to protect themselves.
Among DAIL’s revelations was that its Division of Licensing and Protection is so short-staffed that fewer than one in 10 facilities is visited annually by state inspectors. Ideally, DAIL inspectors should check in on every facility at least once a year.
But DAIL’s own records indicate that three out of four residential-care homes and assisted-living facilities haven’t been seen by inspectors in more than two years, and one in four has gone unchecked for more than four years. Some haven’t had a comprehensive inspection in more than six years.
Unlike nursing homes, which under federal law must be visited regularly by regulators, there is no statutory mandate for how often Vermont’s 109 residential-care homes and eight assisted-living facilities get evaluated. This is especially troubling, Fleming says, given that Vermont is trying to move away from housing its elderly and infirm in expensive nursing homes and opting instead for smaller, more community-based facilities, such as residential-care homes.
Vermont’s aging demographics are likely to exacerbate the problem. According to U.S. Census figures, people over the age of 65 currently make up 14 percent of Vermont’s population. By 2030, that percentage is expected to rise to 25 percent.
“It’s really disconcerting when I get into an elevator and see that it was inspected in April of this year,” Fleming notes, “but we have vulnerable adults living in residential-care facilities that haven’t been surveyed in four or five years.”
Jackie Majoros agrees. As director of the state’s long-term-care ombudsman program, she is charged with overseeing the health and welfare of Vermont’s nearly 7000 vulnerable adults. In her experience, many of the abuse complaints that come to her attention could have been averted if DAIL had more resources to do its job.
Due to issues of confidentiality, Majoros cannot disclose the details of specific abuse and neglect complaints. However, she offers examples of real problems that have been identified at facilities inspected within the last year.
Among them: One residential care home had no records that its staff had received any state-mandated training that year. In another facility, an inspector observed a resident getting half the pain medication she was prescribed. In another, a diabetic resident was receiving insulin shots at the wrong time of day. Such problems, she suggests, represent the tip of the iceberg.
“Good care should not depend on family, friends or an ombudsman filing a complaint on a resident’s behalf,” Majoros says.
Such complaints are filed with Vermont’s Adult Protective Services (APS), usually by family members or caregivers. But Fleming and Majoros concur that only a small fraction of those allegations are being investigated, and an even smaller percentage is substantiated for further action. APS now has a backlog of nearly 500 cases, Majoros adds.
Fleming says she heard from one DAIL employee, “‘If a woman was in bed in a residential care facility and lying in her own feces, we wouldn’t be able to get to her for two to four months.’”
Senecal insists that such a complaint would be investigated within “hours or days,” not weeks or months. But she readily acknowledges that the 17 percent staff reduction in her department has made everyone’s job more difficult.
“But if it was really a life-and-death situation someone was reporting, we would involve law enforcement immediately,” Senecal asserts. “If you’ve got an 87-year-old lady whose drug-abusing son is whaling on her, we’re going to get out there right away.”
Not everyone is so sure. Michael Benvenuto, director of the Senior Citizens Law Project at Vermont Legal Aid, represents elders who’ve been physically, sexually or financially abused or exploited. He suggests that if that same drug-abusing son were draining his mother’s bank account or pilfering her pain meds, it could take weeks or months before that complaint is investigated. If ever.
In fact, Benvenuto had one such case earlier this year in which, he alleges, the state’s delayed response to a financial exploitation charge cost his client literally tens of thousands of dollars.
Benvenuto doesn’t know whether the problems are getting worse this year or if more cases are just being reported. He can say, however, that Vermont’s rate of substantiating allegations of abuse, neglect and exploitation — 7 percent — is among the lowest in the nation.
In fiscal 2009, he notes, APS received 2450 calls of alleged abuse or neglect, of which 994 were investigated. Of those 994 calls, state investigators substantiated only 73 cases statewide.
“I don’t think that APS could possibly defend that, in nearly 1000 cases they investigated, there were only 73 people who were actually abused or exploited,” Benvenuto notes. “So, I don’t think they’re following their statutory mandate.”
However, DAIL’s commissioner warns against drawing comparisons between one state and another, since each state reports its call volumes and investigation rates differently. For example, she explains, if APS gets a phone call from an elderly woman complaining that her neighbor’s dog is barking all night, that case would be screened out and not investigated further.
“I just don’t buy that,” Benvenuto responds. “If a VNA nurse is in the home and thinks a senior is being abused … I don’t see how half those calls are being screened out and not investigated.”
Part of the problem, Benvenuto says, is that, unlike the Department for Children and Families, Adult Protective Services lacks a 24/7 emergency response system that can remove vulnerable adults from dangerous or exploitative situations.
“If DCF has a call that a child is being sexually abused, the police will arrive and DCF can remove that child and place them in protective custody that day,” he says. “But if someone gets a call about a senior being abused, I’ve never heard of a situation in which APS was the first responder and went out there.”
It must be emphasized that Fleming, Benvenuto and Majoros don’t point their fingers at DAIL staff or the commissioner. All three say they believe DAIL is trying its best under extraordinarily challenging circumstances.
Sheila Coniff is a financial administrator in DAIL’s business office. She says that many of her fellow employees are just as concerned as advocates are about their diminished ability to protect vulnerable Vermonters. However, she says, many are reluctant to voice their concerns publicly for fear of “being put on the next RIF list, which we all know is coming.
“The fact that lights are on at DAIL at 8 o’clock at night and people are staggering out the door says a lot,” says Coniff. “My fear is that we’re going to go from being one of the best states in the country to grow old in, to the bottom of that list pretty quickly.”
What needs to be done? Last week, several advocates met with the legislature’s health care oversight commission. Their recommendations included calls for an “independent and extensive evaluation” of the state’s protective services and licensing systems, as well as annual inspections of every residential-care home and assisted-living facility in the state.
Advocates are also asking the state to adopt a “credible and effective emergency response system” for recognizing and responding to abuse, neglect and exploitation charges far more quickly.
Sen. Jane Kitchel (D-Caledonia) tells Seven Days that the oversight commission hasn’t decided what to do with those recommendations yet, but plans to put together a working group of stakeholders to explore these and other issues and report back to the legislature by March 15.
In the meantime, advocates say they intend to keep the pressure on lawmakers to ensure that this problem doesn’t get shoved under the covers.
“Protecting vulnerable Vermonters is not a luxury only when resources allow,” says Fleming. “It’s a basic government responsibility, a moral imperative and an indication of a civilized society.”