Strained Adult Protective Services to get relief July 1, but stakeholders seek more aid

When Jerry Kiefer discovered last November frail elderly people confined in their beds with makeshift cages and locked in their rooms at night, it led to the demise of the unlicensed Kearns Comfort Care residential facility in Greenfield and the prosecution of its operators. The discovery reinforced the same problems he’s seen for 15 years as an adult protective services investigator.

When he discovers a neglected or abused endangered adult, “I have no legal authority to say, ‘I’m taking you, you’re coming with me,’” Kiefer said. “And if I did, I’d have nowhere to take them.”

Kiefer investigates reports of mistreatment of endangered adults in Hancock, Johnson and Shelby counties. He’s the only person who responds to such reports for a region of more than a quarter-million residents.

“The need is now. And it has been for the longest time now,” he said.

Kiefer is one of only 28 investigators of reports of mistreatment of endangered Hoosiers, along with 18 district directors. The Indiana Family and Social Services Administration has pledged to release funds July 1 to hire 18 more investigators, and Kiefer will be happy to have help. But he said more is needed.

“We have been hammering, begging for emergency placement for years,” for endangered victims, he said. “I think most investigators would rather have emergency placement than more investigators.”

Indiana’s unique

Indiana’s system for handling reports about maltreatment of elderly and endangered residents is unique in the nation, said Mike Patterson, director of adult protective services for FSSA. He said no other state operates its adult protective services program out of county prosecutor offices, as Indiana does. “All the other states do it as either a centralized state program or a social services program.

“One of the positions we’ve had all along is we need to take a holistic look at the adult protective services program. It’s going to take a lot more than an influx of a whole lot of money,” Patterson said.

To that end, FSSA and the Indiana Prosecuting Attorneys Council will be meeting over the summer to draft a report on the APS system ordered in Senate Enrolled Act 192. The legislation calls for recommendations on staffing, emergency placement, standards of care, training for investigators and other matters related to endangered adults, defined under I.C. 12-10-3-2.

IPAC deputy director Suzanne O’Malley said she doesn’t believe any structural changes are needed and that placing protective services investigators within prosecutors’ offices “really has made the system work.

“Do we have to have more investigators? Absolutely,” O’Malley said. She said the additional 18 investigators to be hired after July 1 was only like releasing steam from a system that was about to blow due to understaffing. Many more investigators are needed, and she agreed on the need for more services. “You can investigate all you want, but if you don’t have the services to keep that person safe, it doesn’t matter.”

Data lacking

Crider

Sen. Mike Crider, R-Greenfield, authored SEA 192. He said there was little data from which to set policy. “I look at it as a way to get some good data to help us next year during the budget session really dig in to what we really needed to do in this area as a Legislature,” he said.

“It really tries to ask for a pot of money to address some of these challenges. … My suspicion is it will be a bigger number than what’s possible. … I’m going to do my best to try to improve the status and level of protection of these folks. I’m going to get as much as I can in that regard,” Crider said.

The aging of the baby boomer population means a silver tsunami that Kiefer says has already begun and will only build. Crider said the data will form a good baseline from which to set policy for a system that most agree lacks standards and varies widely from county to county.

“More folks are hitting that point where they need some type of intervention, and the goal is to try to have a system that’s balanced and makes sense,” Crider said. He vows to make a case to his fellow lawmakers to adequately fund and reform a system that’s frequently overwhelmed by caseloads and must triage cases on a shoestring.

To Kiefer, one particular piece of data that does exist speaks volumes. He notes the annual budget for animal control in Marion County is greater than Indiana’s entire Adult Protective Services budget.

Seeking unity

FSSA Secretary John Wernert said it’s clear the APS system hasn’t been as effective as it needs to be in identifying people who are at risk or in its ability to respond to reports of endangered adults. He said his agency is committed to working with IPAC to find solutions, and he said everything is on the table.

“IPAC’s involvement as well as this agency’s involvement is necessary to pull together and come up with a unified solution,” Wernert said. “We need to be able to demonstrate we’ve got a serious solution and a serious fix that both IPAC and FSSA can work with. … It’s evident if we keep pouring money into the current system, it’s not going to get any better.”

The state is divided into 18 APS “hubs” or districts, and some districts have more investigators than others based on population and other factors. In addition to reports to APS hubs, reports of abuse or exploitation may come from 911 calls or calls to a toll-free APS number in Indianapolis.

But there’s little coordination on deciding which cases take precedent. Keifer said he makes judgment calls all the time. If he gets a report of financial exploitation and another of abuse, he’s going to chase the abuse allegation first. He estimates he gets about five reports a day, which doesn’t leave much time to build cases. “We kind of fly by the seat of our pants,” he said.

There also are misconceptions about who’s endangered under the statute. It’s narrowly defined and many reports of exploitation don’t meet criteria such as incapacitation or cognitive impairment. Sometimes, O’Malley said, people just make bad decisions. “That doesn’t mean we can step into someone’s life when they have the ability to make those decisions.”

Help wanted

While new APS investigators will arrive soon, Kiefer said an ideal situation would be at least one designated investigator in each of Indiana’s 92 counties, with more in more populous counties. That may be asking too much. As it is, he’s trying to cover three counties by himself with an old deputy’s car retired from the Shelby County Sheriff’s Department. He tries to make sure trips to other counties string a few cases together. “It’s a matter of trying to be productive and cost-effective,” he said.

Despite a system he described as “kind of slapped together,” Kiefer said, “with all its faults, I think it works pretty well. Considering we don’t have a lot to work with, I think we do a pretty good job. I think there’s always room for improvement.”

Then Kiefer recalled a World War II veteran with dementia who had been neglected at Kearns Comfort Care. “It was troubling this could go on,” he said. “That’s not the way it’s supposed to work when you hit that point in your life.”

Unlike Department of Child Services investigators, Kiefer can’t remove an endangered adult when he sees evidence of abuse or neglect. “In my mind, there should be some sort of a system where I have a nursing home or a group home in every county” where he can call in such a case and say, “Get a room ready, get a bed ready, I’m bringing them. … I think it’s doable.

“What is the real difference between someone who’s 98 years old, incapacitated, who doesn’t know who they are and is totally reliant on another, and a 10-month-old?” Kiefer said. “I think they’re very similar, but people just don’t view it that way.”•