Table 2 shows the estimates for 10 Ohio counties that are expected to have the highest incidents of elder abuse (See Appendix, Table A-2, for all Ohio counties). We give an average of APS incidence counts for the past three years in the first column. We multiply these figures by five in the second column to estimate the number of cases of abuse if we use the approach of the National Elder Abuse Incidence Study, which estimates five incidents for each report. Columns 3 and 4 give estimates derived from the Family Domestic Violence Study conducted by Professor Kenneth Steinman in 2010 and published by the Health Policy Institute of Ohio. The final column represents the low-range estimate of elder abuse provided by the National Center for Elder Abuse website: 7.6 percent of seniors.[13]

There is also wide variation in reporting among Ohio’s 88 counties. An unpublished study by the Ohio Coalition for Adult Protective Services found several reasons for this variation:[15]

• Non-reporting agencies. Some Adult Protective Service agencies did not report any incidents of elder mistreatment cases or reported only periodically. This occurred mostly in smaller counties. Under law, submitting incident reports is voluntary. The lack of information on non-compliance makes it unclear whether there are no incidents or just no reporting in these counties.
• Inadequate staffing. The number of full-time staff devoted to APS correlates significantly with number of incidents reported. Counties with full-time APS workers reported higher incidence of mistreatment than counties with part-time staff. Amount of time (full-time or part-time) devoted to APS activities influences availability of workers to receive and process cases.
• Staff Qualifications. Counties with designated APS staff reported more cases than counties that assign Child Protective Service workers to APS. Having specific training for APS is essential and we should not assume the child service workers can do the job well.

The estimates in Table 2 tend to be low because not all problems addressed by APS are included in each study. For example, the 2010 Family Domestic Violence Study did not cover self-neglect, which comprises a significant share of county staff time. In their 2003 assessment of elder abuse and neglect in the state, the Ohio Commission on the Prevention of Injury estimated 38 percent of reported cases were self-neglect cases.[16]

Social services for individuals are needed, but outreach is also needed to find the afflicted and to educate the community. The Ohio Commission on the Prevention of Injury provided a set of recommendations to strengthen the system of APS, including increased outreach, increased surveillance, targeted resources for high-risk groups and empowerment of people in the community to recognize and stop mistreatment, exploitation and neglect.[17]

State funding to implement this kind of protection has never been in place in Ohio. In 2005, the Attorney General’s Elder Abuse Task Force Report noted: “APS in Ohio has a long history of being neglected. As reflected in the history of substandard budget allocations and frequent budget cuts, no entity has ever championed the case for protection of the elderly.[18]

Table 3 illustrates staffing needs in 10 counties corresponding to estimates of incidents of adult abuse. (See Table A-3 in the Appendix for a complete listing of counties). Statewide, an estimated 272 to 714 caseworkers are needed just to administer the investigative service. This does not include supervisory or administrative staff.

Caseworker count was derived by finding a monthly caseload from each estimate of annual estimates (by dividing annual estimates by 12 for a monthly count) and dividing the resulting number by the nationally recommended APS caseload of 25 cases per month.[19] While all counties had reported incidents, some of the reporting was very low. This count provides for at least one caseworker in each of Ohio’s 88 counties.

Table 4 illustrates the cost of adequate caseworker staffing for each estimate of need. Urban, rural and suburban counties show up on this list. A complete list of all counties, listed alphabetically, is in the Appendix in Table A-4. To calculate staff cost, we used the 2013 statewide median salary ($33,809) for ‘Child, Family and School Social Worker’ (Occupational code 21-1021) plus 25 percent for benefits, resulting in a total of $42,261.[20] We multiplied this compensation cost by the number of caseworkers needed according to the different estimates.

The lowest estimate is yielded by the National Elder Abuse Incidence Study methodology, which estimates five incidents of abuse for every incident reported. This calculation finds $11.7 million is needed for an adequate number of caseworkers in the 88 counties. To meet the highest range of the family domestic violence study – which is five years old and which did not include the significant category of self-neglect – $16.2 million would be needed. To address the lowest level estimate of the National Center for Elder Abuse, $30.2 million would be needed.

Abuse of elderly Ohioans is a growing problem and far more prevalent than current statistics suggest. This makes it imperative that Ohio meet its obligations to provide a higher level of protection to vulnerable residents.

A current provision in the house-based appropriations bill of the Mid-Biennium Review (HB 483) would fund Adult Protective Services at $10 million. This is a good start, and where funding should have been for the past decade. Because of the growth in the senior population and the increasing emphasis on serving seniors in homes and the community instead of nursing homes, Adult Protective Services now needs an appropriation of at least $20 million a year. Reports of elder abuse, neglect and exploitation are expected to increase as managed care providers report suspected abuse or mistreatment.

Adequate state support will enable the county departments of job and family services to address the new demands of managed care and home-based care, as well as the full range of investigative focus, including financial mistreatment, addressed in House Bill 49, passed by the House of Representatives of the 130thOhio General Assembly.

Tags