Finding Help: Adult Protective Services

As we discuss how to help an older adult in need, it is important to be aware of the agencies already in place to help you. A few descriptions of those agencies should be helpful. I’ve become aware misconceptions regarding the role of certain governmental agencies--particularly Adult Protective Services (APS).

Adult Protective Services

Briefly stated, the purpose of Adult Protective Services is to assist vulnerable and elder adults in need of protection to prevent or discontinue abuse, neglect, or exploitation until that condition no longer requires intervention.

I was recently asked if APS is similar to Child Protective Services, another important agency set up to protect children. The answer is “Yes and No.” The important distinction to remember is that there is not always a perpetrator of neglect or abuse in the lives of older adults. In fact, the situation I described in the last post is a perfect example of older adults in need. One might assume they are being neglected, but by whom? In a case of child endangerment there is always a responsible party whether that b a parent, foster parent or other guardian. In the case we are discussing here, there is no defined “perpetrator.”

In this case and others like it, Adult Protective Services is the right agency to contact. The beliefs listed below help us understand that the role of APS is really not to lay blame, but to offer services in any case where an older adult is at serious risk.

Guiding Principles or Beliefs

• Services shall be consistent, if at all possible, with the accustomed lifestyle of the vulnerable adult.
• The vulnerable adult has the right to self-determination.
• All services provided are voluntary unless court ordered.
• Services provided should be least restrictive in nature and community based when possible.
• Family members and others who are concerned for the vulnerable adult should be allowed and encouraged to take responsibility. The State will accept responsibility only when no other resource is available.

I want to point out an essential issue here, which is the concept of “self-determination.” When an agency representative investigates a situation where abuse or neglect of an older adult is suspected, they cannot violate or disrupt the person’s “accustomed lifestyle.”

Defining "Self Determination" 

I would like to refer you to a post that addresses this point titled, Intervening in the Decision Making of Your Aging Parent.  In that post, Anthony Morrison parses this dilemma and provides a step-by-step process that emphasizes the least restrictive intervention.

A Great Question!

So here’s where it gets tricky. When does the risk of self harm trump self-determination? Great question! And it’s one that APS agency workers confront regularly.  As you might imagine, there is no simple answer to this question.  Every case is different and in every case the worker must be willing to consider many complex issues including answering:

• What constitutes “Immediate and Real Danger?”
• Who is being harmed by the decisions made by the older adult?
• At what point should a Public Guardian be considered?
  

Now What?
 
I have spoken with many professionals regarding this issue and received a number of suggestions. The most common one is very practical. If you believe and older adult is in danger of self-harm, neglect or a victim of abuse, call Adult Protective Services, ask to speak with a professional agency representative such as a social worker and then discuss the situation.  If you choose, the call can be made anonymously. By calling and speaking with someone well versed in the nuances of the law and the agency’s role, you can ask general or specific questions without ever mentioning the older adult’s name. 

Making this call will often provide you with enough information to then decide your next step.  After this initial call, you may wish to then seek counsel from others in the neighborhood, clergy or even a distant relative that you know cannot be present.

I welcome comments on this post.  Remember that I am speaking generally about a topic that can be extremely complex.  Please feel free to submit questions you have about this topic or about a more specific situation or dilemma.

            Grow old with me!  The best is yet to be.  ~Robert Browning

Worried Neighbors, Solitary Elders, Good Samaritans

I’m so glad to be back at the blogger’s desk and writing about an important issue.  It first came up when a woman approached me at a local street fair here in Salt Lake City. She came to the office a few weeks later with a particularly difficult and perplexing situation—one that has taken me some time to research.

Gratefully, I work with several mental health professionals who represent many decades of experience working with older adults. I went to our weekly meeting and was offered many helpful responses that I would like to share over the next few posts.

The Situation

The woman who came to our office said she lived in a neighborhood where she knew of a woman living alone. The older woman was eighty years old and very isolated from the normal social engagements that occupy many of us in middle age.  This woman was clearly in desperate need of help.  I’ll call her Mrs. Smith.

It was reported that Mrs. Smith has lived alone for many years in a home she apparently owns.  She has no family in the area—in fact, it appears that her only living family member is a brother who lives in a distant country. It is not clear whether this brother has contact with his sister here in the States—but if he does, it appears that he is unaware of his sister’s situation and needs.

Mrs. Smith is described as very suspicious—maybe even paranoid. She refuses to allow visitors into her home except in the direst emergency.  She has fallen ill on several occasions following incidents where she has ingested spoiled food.  The neighbors have made many efforts to help this woman but they have been rebuffed.  Only when Mrs. Smith has been too ill to respond to her door have the neighbors felt obliged to enter the home and have Mrs. Smith transported to the nearest emergency room.  Once Mrs. Smith is well again, she returns to her home and to her reclusive life.

As I described this situation with professionals who work with older adults I learned that this situation is sadly not uncommon.  The neighbors’ efforts to help and resulting frustration is also familiar.  The questions nagging at those in the neighborhood include:

•    When does our concern for our neighbor’s safety override her right to privacy and self-determination?
•    If we know this woman is at risk of self-harm, what state agencies, if any, can provide us with counsel and help? 
•    Is this a case for Adult Protective Services? 
•    Does our county Aging Services have outreach workers that can help us help her? 

These are the questions I have pondered over the last few weeks.  They are questions that are actually being asked by many thoughtful, concerned neighbors as well as by family members who may be estranged from an aging parent, aunt or uncle or even a more distant relative with limited resources.
I will attempt to offer some answers to these questions in the next few blog posts. I’m keenly aware that as I attempt to answer these questions, more questions will be posed than I have answers to.  I encourage your comments and suggestions throughout this process.

My next post: A Few Definitions