Civil Grand Jury County of LOS Angeles

Conclusions 6

• CL1
  An annual grant of $15 million. This grant will be available from 2009-2013 and would require that an extensive search be conducted for suitable relatives with whom a foster child may be placed. These supplemental funds would be used to expand the existing “Family Connections Grant.” These grants are competitively awarded to public welfare agencies and/or eligible private non-profit agencies for residential family treatment centers.
• CL2
  It would also mandate that 3% of these funds be used to evaluate and oversee grantee programs such as intensive family-finding efforts and family group decision-making meetings.5 4.0 AB12 Existing law, through the Kinship Guardianship Assistance Payment Program (Kin- GAP), which is a part of the CalWorks program, provides aid on behalf of eligible children who are placed in the homes of relative caretakers. The program is funded by state, county and available federal funds. California Assembly Bill 12 was introduced in the State Legislature on December 1,
• CL3
  Requires a state to provide assurances that each school-age child who receives federal (Title IV-E) assistance (whether in foster care, kinship guardianship or adoption) is enrolled in school full-time (or has completed high school).15 HR6893 clearly states its commitment to additional funding for both academic pursuits as well as vocational training. Therefore, the energy expended in supporting the passage of AB12 must be definitive and unclouded. Finding 6.1 If AB12 is enacted by the State of California, in accordance with the conditions enumerated in HR6893, specific educational requirements will need to be met for all children in foster care. Such requirements will certainly have costs associated with the required provisions. However, it is important to note that HR6893 also provides for such services to be reimbursed by the federal government. 7.0 Conclusion “At eighteen, foster care children currently exit the system. Most do so, without any benefits. They have a substandard education. Fifty-one percent who “age-out” of the foster care system are unemployable, and as a result, are homeless within eighteen months. Nearly 70% of those incarcerated, in California, are products of the foster care system, in some manner. The system has forsaken these youths.”16 By almost any standard, the foster care system has failed to provide the nurturing and healthy environment that children need if they are to grow to be mature adults capable of competing in the world of the 21st Century. This is not to say that the agencies involved in servicing these youths lack good intentions. Nor can it be said that the individuals who are charged with providing support in the affected agencies are not interested in helping the children. However, the caseloads of CSWs are too great. The systemic and endemic problems associated with growing up in the second largest city and the largest county in the nation are complex. The financial obligations of the State 15 Congressional Research Service, memorandum, Washington, D.C., September 15, 2008. 16 AB12 Fact Sheet 2008-2009 Los Angeles County Civil Grand Jury Report 285 and the County to care for those who have the weakest voices, is a heavy burden. It is incumbent upon those engaged in these efforts to seek every available opportunity to offer more, to seek to provide a better long-term outcome and to continue to fight against all odds on behalf of our at-risk youth. In states that currently do provide foster care to children until age 21, the evidence is clear. The long-term outcomes for these children are dramatically improved. Now, the State of California has the opportunity to enact legislation that will do exactly what other states have already chosen to do, specifically, extend the age at which children continue to be able to receive the services and support of the County agencies until they reach 21. This can be accomplished with no increase in costs to the County. With this in mind, it is important for those in the County to continue to advocate on behalf of those who can’t speak for themselves and to strongly support the enactment of state Assembly Bill 12. Passage of AB12 would demonstrate the on-going government commitment to those who cannot advocate for themselves. 286 2008-2009 Los Angeles County Civil Grand Jury Report EXTENDING FOSTER CARE FROM AGE 18 TO 21 “SO I’M EIGHTEEN, NOW WHAT?” FINDINGS AND RECOMMENDATIONS Finding 1.1 At the present time, foster care children exit the system around the age of 18 without the proper preparation for adult living or the necessary survival skills. Finding 4.1 As of April 2009, four states have already enacted bills similar to AB12 that establish their commitment to the principles outlined in HR6893.
• CL4
  Assess and evaluate the processes, procedures and accountability structures governing contracts with third party agencies and organizations that are providing elder and dependent adult abuse prevention services on behalf of the County. This investigation comes at a time when the elderly population and number of reported cases of elder abuse is growing dramatically in Los Angeles County. The United States Census Bureau projects that California’s elderly population will more than double, from approximately 3.6 million to more than 8.3 million, by the year 2030. The County of Los Angeles, which had a population of nearly 10 million people in 2000, has more residents than any county in the nation. According to the California Department of Finance (CDOF), there were 937,442 seniors in Los Angeles County in 2000, and the elderly population is growing steadily as the Baby Boomer generation ages. The CDOF estimates that the County’s elderly population will reach approximately 1.2 million by 2010, 1.6 million by 2020, and 2.2 million by 2030, which is nearly a 138 percent increase in 30 years. In addition, while seniors comprised only about 10 percent of the total population in 2000, they will comprise about 19 percent of the total population by 2030. In Los Angeles County, there are numerous County and local agencies, private contractors, task forces and advisory committees involved in elder abuse prevention services either directly or as a secondary component of their services (e.g., the Department of Mental Health serves all ages but is involved in preventive activities for elder clients vulnerable to abuse). The scope of this investigation includes the cost, management oversight and administration of elder abuse services provided by County agencies and contractors to the County. The County’s Community and Senior Services (CSS) Department is responsible for operating the federal- and State-mandated2 Adult Protective Services (APS) program. APS operates a 24-hour a day hotline for reporting suspected elder abuse. Social Workers investigate these reports and, if confirmed, develop service plans to remedy the situation in which the abuse is occurring. 2 The Older Americans Act and Older Californians Act delineate these mandates. 292 2008-2009 Los Angeles County Civil Grand Jury Report APS Social Workers coordinate their efforts with outside public and private agencies, including law enforcement, the County Department of Mental Health (DMH), the Public Guardian, Senior Centers and other private nonprofit and public agencies. To varying degrees, these partner organizations also play a role in elder abuse prevention and are staffed by mandated reporters.3 Another service for elders at CSS, but separate from APS, is the Area Agency on Aging (AAA), which is also a federal- and State-mandated program responsible for identifying unmet needs, planning, coordinating and implementing programs that promote the health, dignity and well-being of elders. The AAA contracts with 49 community agencies to deliver services to promote elder independence, including senior lunches, home-delivered meals, nutrition programs, care management and home-based care. One of AAA’s non-profit contractors, WISE & Healthy Aging, administers the Long-Term Care Ombudsman Program and an Elder Abuse Prevention Program, and another contractor, Bet Tzedek, provides legal services to the elderly population. Other County agencies and programs that are involved in aspects of elder services include: • Department of Public Social Services (DPSS), which administers the In-Home Supportive Services program4 • Office of the District Attorney’s Elder Abuse Section, which prosecutes cases involving elder abuse • Department of Consumer Affairs (DCA), which provides fraud prevention and protection services to elders and dependent adults • Department of Health Services (DHS), which administers a hospital-based elder and dependent adult abuse assessment and intervention program at two medical facilities within the County health services system While elder abuse prevention is not necessarily the key function of these organizations, they play a role in elder abuse prevention services through their regular contact with elders in potentially abusive situations. The following procedures were performed: Entrance Conference: An entrance conference was held with the Director of Community and Senior Services (CSS) and pertinent managers of Adult Protective Services (APS) and the Area Agency on Aging (AAA) to initiate the investigation, 3 California Welfare and Institutions Code Section 15630 defines specific professions that are mandated reporters, including APS workers, law enforcement, health practitioners, staff of facilities that provide care of services for elders, staff of AAA and similar agencies, In-Home Supportive Service workers, and others. 4 In-Home Supportive Services (IHSS) is a program that helps pay for services such as meal preparation and household assistance, provided to eligible persons who are 65 years of age or over, or legally blind, or disabled adults and children, so they can remain safely in their own homes. IHSS is considered an alternative to out-of-home care such as nursing homes or board and care facilities. 2008-2009 Los Angeles County Civil Grand Jury Report 293 describe the investigation’s objectives and timeline, obtain an overview of elder and dependent adult abuse prevention services, and respond to questions. A request for background information was also submitted prior to the entrance conference. County Chief Executive Office Interview: An interview was conducted with representatives of the County Chief Executive Office. County-wide information on elder and dependent adult abuse prevention services was also collected and analyzed. Community and Senior Services Interviews: Interviews were also conducted with representatives of CSS, including the Director of the Department and managers of APS, for details on elder and dependent adult abuse prevention services. Strategic Planning Documents: The County’s strategic and other planning documents related to elder and dependent adult abuse prevention services were collected and evaluated. Caseload and other measures of effectiveness were also reviewed. Agency Interviews: Interviews were also conducted with representatives of at least six other agencies and organizations involved in elder and dependent adult services to obtain complete descriptions of and information about their services and how they interact with APS: • Office of the District Attorney • Department of Health Services • Department of Mental Health • Public Guardian • Department of Public Social Services • The non-profit contractor, WISE & Healthy Aging An interview was also conducted with the Elder Abuse Task Force, which is a partnership of the Los Angeles County Superior Court and various public and private agencies and organizations. Expenditure Records: The County’s expenditure records for major elder and dependent adult abuse services were obtained and analyzed. This included identifying administrative costs, an inventory of contract services costs, and basis for payment of contractor fees. Elder and Dependent Adult Abuse Hotline Calls: Trends and distribution of calls to the elder and dependent adult abuse hotline administered by APS were reviewed to assess the effectiveness and awareness of elder abuse reporting by County agencies and programs. This included an assessment of the means by which information about APS is disseminated to other County agencies and the public. Policies and Procedures on Reporting Abuse: The consistency of written policies and procedures and employee awareness of protocols governing other agencies’ identification and reporting of suspected elder and dependent adult abuse to APS were assessed. 294 2008-2009 Los Angeles County Civil Grand Jury Report Draft Report: On March 31, 2009, a draft report was prepared and provided to CSS. The draft report presented the following findings, conclusions and recommendations: • The County’s strategic planning for elder and dependent adult abuse prevention • Elder and dependent adult abuse outreach and publicity efforts • APS monitoring of hotline calls • The APS current and projected caseload • Referrals to other agencies and case outcomes • APS analysis and management of other agency activities • APS training • APS utilization of multidisciplinary teams for elder and dependent adult abuse prevention Exit Conference: An exit conference was held with pertinent managers of CSS to obtain their views on the report findings, conclusions and recommendations, and to make corrections and clarifications as appropriate. Final Report: A final report was prepared following the exit conference. Adult Protective Services and its Key in Abuse Prevention The County Adult Protective Services (APS) program helps elders (65 and older) and dependent adults (physically or cognitively impaired 18-64 year olds) living in the community who are suspected victims of abuse or neglect (including self-neglect). APS Social Workers investigate reports of alleged abuse in the community; assess an individual’s abilities and limitations; provide referrals to community services; and provide general case management to help those that are unable to protect themselves. APS Budget and Staffing In FY 2008-09, APS has a current modified budget of $28,168,750. As shown in Table 1.1, the FY 2008-09 budget consists of $24.2 million for APS staff salaries and administrative support, $3.7 million for operating costs, including approximately $1.4 million for services provided by the program’s partner agencies based on Memorandums of Understanding (MOUs), and another $240,000 for APS contractors that provide emergency services to seniors. The $3.7 million also includes $2.3 million in other operating costs, such as rent on commercial property, custodial services, information technology services, supplies, and mileage reimbursement. The APS emergency shelters, which include board and care homes, guest homes, retirement homes and residential facilities, are under contract to provide emergency services to elders referred by Community and Senior Services. Each shelter is allocated $30,000 per fiscal year but is paid based on reimbursement of costs for actual services provided. In FY 2007-08, $300,000 was budgeted for 10 APS emergency shelters, but only $120,544 was paid for actual services provided. Furthermore, the number of emergency shelters for which APS was budgeted funds has reduced from 18 in FY 2006-07 to eight in FY 2008-09. 2008-2009 Los Angeles County Civil Grand Jury Report 295 In addition to APS’s budgeted costs, another $4.7 million is allocated to elder abuse prevention through the Area Agency on Aging, which is also housed in Community and Senior Services. A full description of this amount is provided at the end of this Introduction. Assistance Budget Decreased and Administrative Costs Increased Table 1.1 also provides a comparison of the APS budget in FY 2006-07, FY 2007-08 and FY 2008-09. As shown, the APS program’s total budget has increased by about 7 percent from FY 2006-07 to FY 2008-09. While both administrative and operating costs have increased, the assistance budget has decreased by about 85 percent, resulting primarily from the elimination of Integrated Care Management (ICM) contracts from the APS budget. The funds were moved within CSS to the Area Agency on Aging. The number of board and care homes, guest homes, retirement homes and residential facilities was funded with assistance monies has also decreased from 18 homes and facilities in FY 2006-07 to eight in FY 2008-09. 296 2008-2009 Los Angeles County Civil Grand Jury Report Table 1.1 Adult Protective Services Current Modified Budget Including Contract Services FY 2006-07, FY 2007-08 and FY 2008-09 3-Year Percent FY 2006-07 FY 2007-08 FY 2008-09 Change APS Operations Salaries $14,869,000 $15,923,000 $17,901,000 20% Admin Support 6,875,000 6,459,000 6,313,500 -8% (CSS + APS) Total Admin 21,744,000 22,382,000 24,214,500 11% Partner Agencies/Operations Consumer Affairs $200,000 $200,000 $200,000 0% District Attorney 142,000 142,000 142,000 0% Health Services: 460,409 421,375 457,500 -1% MLK MACC Health Services: 454,591 454,591 457,500 1% LAC+USC Mental Health: 71,000 71,000 71,000 0% GENESIS Mental Health: 71,000 71,000 71,000 0% Public Guardian Other Operating 1,657,000 2,058,034 2,315,250 40% Costs Total Operating 3,056,000 3,418,000 3,714,250 22% Direct Services Emergency $540,000 $300,000 $240,000 -56% Shelters Integrated Care 1,108,734 0 0 -100% Management Total Assistance 1,648,734 300,000 240,000 -85% Total APS $26,448,734 $26,100,000 $28,168,750 7% Source: Adult Protective Services, FY 2006-07, FY 2007-08 and FY 2008-09 Budget 2008-2009 Los Angeles County Civil Grand Jury Report 297 By comparison, the APS budget for MOUs with partner agencies, including the Department of Consumer Affairs, Office of the District Attorney, Department of Health Services5, and Department of Mental Health6, has remained relatively constant at about $1.4 million. The MOUs require APS’s partners to submit monthly financial status and progress reports, as well as a bill or internal voucher showing expenditures for prior month activities. APS bases payments on actual costs justified by supporting documentation. In FY 2007-08, each of APS’s partners except the Department of Health Services Martin Luther King Jr. Multi-Service Ambulatory Care Center (MLK MACC) expended all funds that were budgeted. Actual costs for MLK MACC totaled $381,334, or $40,041 short of the budgeted amount. Similarly, MLK MACC spent only about 47 percent of budgeted funds in FY 2006-07. The majority of the APS budget is funded by federal and State sources. Based on the FY 2008-09 Proposed Budget, the County’s net cost of the APS program amounted to $271,000, or about 1 percent.7 The Proposed Budget included 223.0 budgeted positions for the APS program. Memorandums of Understanding with Partner Agencies In FY 2008-09, APS has entered into six Memorandums of Understanding (MOUs) with other County departments or programs for the provision of services related to elder and dependent adult abuse. The services and budgeted cost of these MOUs are summarized below: Department of Consumer Affairs (DCA): DCA receives $200,000 annually to provide expanded fraud protection services to abused, neglected and financially exploited seniors and dependent adults. DCA agrees to provide fraud prevention and protection services to clients referred by APS, including: (1) problem assessment and evaluation; (2) counseling, educational and outreach services; (3) information and assistance; (4) complaint investigation and mediation; and (5) consultation to APS staff and other service agencies assisting the client. Office of the District Attorney (DA): The DA receives $142,000 annually to enhance the investigative, prosecutorial and educational resources that are dedicated to protecting the elderly and dependent adult population from abuse and to maximize their safety and dignity. The MOU with the DA provides for the following: (1) site visits to law enforcement facilities for the purpose of investigative collaboration; (2) consultation with APS staff and law enforcement officers regarding the viability of case prosecution and preparation; (3) maintenance of a list of physicians with expertise in geriatric and forensic medicine for case referrals; and, (4) at least eight trainings of APS staff in legal 5 Includes both LAC+USC Medical Center and Martin Luther King Jr. Multi-Service Ambulatory Care Center. 6 Includes both the Geriatric Evaluation Networks Encompassing Services, Intervention and Support Field Capable Clinical Services Program and Public Guardian. 7 County of Los Angeles, FY 2008-09 Proposed Budget, Volume One, Page 15.10. 298 2008-2009 Los Angeles County Civil Grand Jury Report issues encountered in criminal cases of elder abuse, as well as procedures encountered in criminal court. Department of Health Services (DHS) LAC+USC Medical Center: DHS receives $457,500 annually to expand the availability of early hospital-based intervention, medical treatment, forensic services, discharge planning and follow-up care, community outreach, and community-based medical assessments for victims of elder and dependent adult abuse through the Violence Intervention Program at LAC+USC Medical Center. Funds for this project are exclusively for clients or potential APS clients. Department of Health Services (DHS) Martin Luther King Jr. Multi-Service Ambulatory Care Center (MLK MACC): Similar to the MOU with LAC+USC just discussed, DHS receives $457,500 annually to expand the availability of early hospital- based intervention, medical treatment, forensic services, discharge planning and follow- up care, community outreach, and community-based medical assessments for victims of elder and dependent adult abuse through the Geriatrics Program at MLK MACC. Funds for this project are used exclusively for APS clients or potential APS clients. Department of Mental Health (DMH) Geriatric Evaluation Networks Encompassing Services, Intervention and Support (GENESIS) Field Capable Clinical Services (FCCS) Program: DMH receives $71,000 annually to expand the availability of gero- psychiatric assessments for APS clients age 60 and over, who exhibit mental health problems or symptoms which appear to jeopardize their safety and/or the safety of others. The GENESIS FCCS Program provides comprehensive mobile mental health assessment and intervention services to APS clients referred by APS, whose safety and protection would be enhanced through the provision of such services. The program is targeted to serve an average of seven new APS clients per month, as funding allows. The GENESIS FCCS Program typically expends all APS funding within the first half of the fiscal year, usually by November or December. Upon depletion of APS funding, APS continues to make appropriate client referrals to the GENESIS FCCS Program, but these cases are not subject to the same timeframe and reporting requirements as those covered under the MOU. The total cost of APS clients served by the GENESIS FCCS Program amounted to $319,139 in FY 2007-08 and $204,469 during the first half of FY 2008-09. Furthermore, APS client costs comprise only about 9 percent of the total cost of the DMH program. Department of Mental Health (DMH) Public Guardian (PG): DMH receives $71,000 annually to provide probate conservatorship services to APS clients, including those with dementia, for their safety and protection. With the funds, PG staff are made available to serve an average of eight clients per month. APS funding covers very little of the Public Guardian’s expense to serve elders and dependent adults because of the attorney, probate investigation and health care costs that are typically involved. According to PG staff, a case can cost an average of between $8,000 and $15,000 the first year the PG is appointed. After the first year, a case may cost an average of $2,000 to $6,000 per year. These expenses are taken out of the PG’s operating budget, which amounted to $15,443,147, including $4,475,746 for 2008-2009 Los Angeles County Civil Grand Jury Report 299 probate cases, in FY 2007-08. The budget increased by nearly $2.0 million in FY 2008- 09, though the probate portion increased by only $288,130 to $4,763,876. APS Caseload Grows by 10 percent in Four Years Studies indicate that each year, an estimated 2.5 million Americans are the victims of elder and dependent adult abuse or neglect. In Los Angeles County alone, APS, in recent years, has received approximately 1,800 to 2,200 new referrals per month, or more than 22,000 new referrals per year. The APS caseload is projected to increase from 25,518 clients served in FY 2005-06 to 28,000 clients expected to be served in FY 2008-09, nearly a 10 percent increase in caseload in just four years. In FY 2007-08, based on data reported to the State, APS received a total of 26,278 unduplicated reports of alleged abuse through its Central Intake Unit, which operates the Elder Abuse Hotline.8 Of these reports, almost half, or 14,784 were for elder abuse and 11,494 were for dependent adult abuse. During the same period, the APS caseload included the following (note: these are not unduplicated counts so they cannot be added together to equal the total number of cases opened): • 25,130 cases opened • 24,823 cases closed • 647 cases where the report was evaluated, but no in-person investigation was conducted9 • 25,890 investigations were completed • 110 cases where the client received emergency shelter • 1,706 cases where the client received tangible or non-tangible support services Based on the Proposed Budget, the FY 2008-09 projected caseload for APS includes the following: • 28,000 clients served (unduplicated annual total) • 2,370 reports of alleged abuse or neglect received per month on average • 2,230 investigations conducted per month on average • 1,250 persons receiving preventative services • 1,200 cases with inconclusive evidence of abuse or neglect • 110 reports received after business hours that required an on-call worker to respond (monthly average) • 225 reports of alleged abuse or neglect received after business hours • 750 cases with confirmed financial abuse10 The Long-Term Care Ombudsman Program Has Been Severely Cut Similar to the APS program, the Long-Term Care Ombudsman is a federal- and State- mandated program whose mission is to protect the rights and dignity of residents in skilled nursing and residential care facilities throughout Los Angeles County. 8 California Department of Social Services, Data Systems and Survey Design Bureau, Adult Protective Services and County Services Block Grant Monthly Statistical Report (SOC 242). 9 This may include referrals that were forwarded to the Information and Assistance Unit or clients that refused services because of their right to self-determination. 10 County of Los Angeles, FY 2008-09 Proposed Budget, Volume One, Page 15.10. 300 2008-2009 Los Angeles County Civil Grand Jury Report Ombudsmen staff educate residents and their families about their rights in these facilities, help resolve complaints and address a variety of issues.11 WISE & Healthy Aging administers the Long-Term Care Ombudsman Program through a contract with both the City and County of Los Angeles Area Agency on Aging (AAA). In FY 2007-08, the Long-Term Care Ombudsman Program conducted 14,433 unannounced visits to skilled nursing facilities and 9,139 unannounced visits to residential care facilities for the elderly in the City and the County of Los Angeles.12 Primarily as a result of these visits, the program investigated a total of 19,970 complaints, including 2,086 complaints of abuse, that same year. Whereas, many elder abuse cases were previously identified during unannounced visits conducted by Ombudsmen staff, the program is currently reliant on calls from residents, family members, friends, staff and mandatory reports for complaints as a result of a State budget cut. In September 2008, the Governor utilized his line item veto authority to cut State General Fund funding for local ombudsman programs retroactive to July 1, 2008. Although local programs retained federal funding and citation funding, the State program also redistributed federal funds at the local level. These changes resulted in a loss of $1,109,783 million in funding, or 49 percent of the Long-Term Care Ombudsman Program’s budget, in FY 2008-09. Since federal and State monies for local ombudsman programs are passed through the AAA, program revenues from both the City and the County of Los Angeles were affected. For example, program revenues from the County of Los Angeles dropped from $1,353,020 in FY 2007-08 to $518,096 in FY 2008-09. To deal with the State budget cut, the program was forced to eliminate 22 positions and four locations throughout the City and the County of Los Angeles. While the total impact of the State budget cut on services is yet unknown, program staff estimate that more than 12,000 unannounced visits, the primary source of complaints, will not be conducted in FY 2008-09. This is approximately a 50 percent reduction in the number of visits that they will perform. Staff also estimate that more than 11,500 cases, including allegations of abuse or neglect, will not be investigated. There is currently no plan to reinstate or provide alternative funding for this program in the County. Area Agency on Aging While CSS management reports that the Area Agency on Aging (AAA) functions and responsibilities will eventually be merged with APS, it is currently separate from APS 11 This includes facility staff training, attitudes, response and behavior; admission and discharge matters; nutrition and dietary concerns; physical therapy; matters of dignity; Medicare, Medi-Cal, and SSI; and other relevant issues. 12 There are 388 skilled nursing facilities with the capacity to serve 38,631 residents, and 1,428 residential care facilities for the elderly with the capacity to serve 34,855 residents, resulting in a total of 1,816 long- term care facilities with the capacity to serve 73,486 residents in the City and the County of Los Angeles. Wise and Healthy Aging Agency, Facility and Bed Count, 2008. 2008-2009 Los Angeles County Civil Grand Jury Report 301 under the CSS umbrella. As previously mentioned, the AAA contracts with 49 community agencies to deliver services to promote elder independence, including: • Senior lunches • Home-delivered meals • Nutrition programs • Care management • Home-based care The AAA also provides funds to non-profit and public agencies to provide job skills to unemployed low-income individuals 55 years and older. Table 1.2 provides the current performance measures utilized by the AAA and some context for the level of services provided through AAA nutrition, Integrated Care Management, and Family Caregiver Support programs. Table 1.3 provides a summary breakdown of budgeted funds for all AAA programs for FY 2006-07 through FY 2008-
• CL5
  WISE & Healthy Aging also has several brochures, including one that provides an overview of its Elder Abuse Prevention Program, another that provides an overview of the Long-Term Care Ombudsman Program, and yet a third that serves as a resource guide related to elder abuse. If the County would like to wage an effective campaign publicizing elder abuse identification and reporting, it should develop a unified, cohesive and complementary set of materials that can be used by multiple agencies and at various events. It should provide all the resources available in one document and identify the attributes of abuse. While this would not preclude agencies from continuing to provide their own brochures to clients, it would assist the County in sending a clear message about elder and dependent adult abuse to the public at large. The new materials would also provide seniors and their caregivers with a first point of contact, such as APS and the Long-Term Care Ombudsman. The Public Information Office, which is one of three sections of the Chief Executive Office’s Public Affairs Office, should be tasked with this responsibility since it serves as 328 2008-2009 Los Angeles County Civil Grand Jury Report the County’s centralized source of information for the public. For example, the Public Information Office is responsible for: • Developing informational materials about the County • Responding to public inquiries via telephone, mail, e-mail, and at its public counter • Disseminating County documents (such as the budget, Civil Grand Jury reports, and audits) • Serving as the media liaison for the County, both as spokesperson and in the capacity as landlord of the pressrooms in County buildings • Developing materials for the County Internet home page • Responding to the e-mail sent via the home page County fails to engage Media to Publicize Elder and Dependent Adult Abuse County agencies, APS and DA, do not actively engage the media through press releases and interviews. The issuance of press releases and scheduling of interviews is important because of the role they play in helping to control the message and keep elder and dependent adult abuse in the public eye. When asked about media outreach, APS listed interviews with the Los Angeles Daily News, Telefutura Channel 46, Telemundo Channel 52, Supervisor Burke’s Television Show, KABC Channel 7, Super Estrella Radio, Cable Television, and Guadalupe Radio. These interviews took place between FY 2006-07 and FY 2008-09, with an average of only three interviews conducted per year. Staff with APS stated that they have targeted Spanish media because within the Spanish community, abuse is almost never reported as a result of cultural values and beliefs. APS also hopes to have an interview with an Armenian television station in the near future. While the DA’s Elder Abuse Section files hundreds of cases each year, few cases are publicized. In 2008, the DA’s Office issued only four press releases on elder abuse cases26 but filed a total of 157 cases throughout the year. Based on filings, only about 2.5 percent of cases are being publicized. DA staff report that deputies in the Elder Abuse Section refer all major crimes and significant cases of public interest to Media Relations. However, even if a case is not referred, cases that are filed are a matter of public record. Crime reporters at various new agencies track these cases and report on those that are newsworthy. Since many victims of elder abuse are reluctant to report their abusers to law enforcement, many of whom are family members and/or caregivers, DA staff believe that greater press coverage may have a further chilling effect on the willingness of witnesses to come forward. Information is Prevention According to staff with the Superior Court, if elder and dependent adult abuse cases were publicized more, it might become more socially unacceptable – similar to domestic violence – and take place less often. The DA’s Director of Communications should 26 Figure based on the press releases shown on the website of the District Attorney’s Office. 2008-2009 Los Angeles County Civil Grand Jury Report 329 therefore attempt to increase the number of press releases that are issued on elder and dependent adult abuse cases that are filed, including cases that are taken to trial, while continuing to provide victims and witnesses of abuse some protection. This may require the Elder Abuse Section to increase the number of cases that it refers to Media Relations. County Needs an Overall Communications Plan Subsequent to the adoption of an APS elder abuse strategic plan, the Directors of the Department of Community and Senior Services and Public Information Office should work together to develop a County-wide communications plan for publicizing elder abuse, reporting avenues, service eligibility requirements for the public, and services for victims. The Communications Plan for publicity and outreach goal should be: • To reach the widest possible audience in Los Angeles County • To improve awareness and identification of elder abuse • To tell clearly how and where to report abuse and what to do about it Combining budgets and/or costs of current materials by several of the 20 agencies could result in significant savings allowing for the printing of outreach materials that would be used County-wide. Requiring the Public Information Office or other personnel to devote time to writing and issuing press releases would not create an additional cost. Public Service announcements to educate the community on elder abuse identification and reporting can be free (by FCC regulations) and the Internet is free. At the same time, by utilizing demographic, zip code data to better target outreach efforts, the County should be able to identify ways to utilize existing funds in a more cost-effective manner. Findings and Recommendations Finding 2.1 Current outreach conducted by APS is more reactive than proactive and not based on any analysis of demographic data showing where the risk of abuse or need for services may be greatest.
• CL6
  Congregate meals are provided by a combination of the local community-based organizations and city agencies. Almost half of the budget goes to meals. 302 2008-2009 Los Angeles County Civil Grand Jury Report Table 1.2 Area Agency on Aging Performance Measures Actual Actual Estimated Projected Performance Measures 2005-06 2006-07 2007-08 2008-09 Indicators Percent of clients who reported that it would be difficult to remain 84% 85% 85% 85% independent in their home without home delivered meals Percent of clients who reported they ate more food because they 72% 73% 73% 75% attended the Senior Nutrition program Percent of clients who reported they enjoyed the healthy food at 91% 91% 91% 95% congregate meal sites Operational Measures Number of home delivered meals 936,464 858,977 984,200 922,300 a served Cost per home delivered meals $4.46 $4.46 $4.75 $4.75 served Unduplicated number of senior nutrition congregate meal 27,564 26,080 26,100 26,100 participants Number of congregate meals 1,348,755 1,350,843 1,350,800 1,273,700 b served Cost per congregate meals $3.90 $4.10 $4.35 $4.35 Number of Integrated Care 10,081 10,224 10,000 c 10,000 Management clients served Family Caregiver Support clients 2,675 2,568 2,580 2,600 served Family Caregiver Support cost per $1,190 $1,000 $1,000 $1,000 client Source: CEO’s Recommended CSS Budget, FY 2008-9. a Decrease is attributable to an increase in the average cost per meal. b Decrease is attributable to an increase in the average cost per meal. c Decrease is attributable to a decrease in funding. 2008-2009 Los Angeles County Civil Grand Jury Report 303 Table 1.3 Area Agency on Aging Budget FY 2006-07, FY 2007-08 and FY 2008-09 3-Year FY 2006-07 FY 2007-08 FY 2008-09 Percent Final Final Original Change Administration Area Plan Admin 1,500,449 1,535,614 1,555,790 3.7% HICAP Admin a 57,632 57,880 58,089 0.8% Title V Admin b 145,266 161,496 161,496 11.2% Total Admin 1,703,347 1,754,990 1,775,375 4.2% Area Plan- Direct Services Supportive Services 837,034 1,569,418 1,254,837 49.9% Family Caregiver 262,001 1,587,559 768,329 193.3% Support Total Direct Services 1,099,035 3,156,977 2,023,166 84.1% Area Plan- Contracted Services Supportive Services/ Elder Abuse 5,799,940 5,036,477 4,693,443 -19.1% Prevention/ Ombudsman Nutrition/Home Delivered/Congregate 10,676,817 11,595,117 10,343,785 -3.1% Meals Programs Disease Prevention 408,339 465,956 443,590 8.6% Family Caregiver 3,245,891 1,810,532 1,471,889 -54.7% Support Community Based 1,173,094 1,173,094 1,079,243 -8.0% Services Program Federal Citation 280,127 294,048 295,367 5.4% Penalty Account Total Contracted 21,584,208 20,375,224 18,327,317 -15.1% Services HICAP Program 922,431 797,578 789,871 -14.4% Title V Program 2,323,131 2,715,469 2,324,165 <0.1% PROGRAM (Area 25,928,805 27,045,248 23,464,519 -9.5% Plan, HICAP, Title V) Total AAA (Admin and 27,632,152 28,800,238 25,239,894 -8.7% Program) Source: CSS AAA Programs, FY 2006-07, FY 2007-08 and FY 2008-09 Budget. a HICAP: Health Insurance Counseling and Advocacy Program b Title V programs provide part-time jobs for unemployed low-income people aged 55 and older. 304 2008-2009 Los Angeles County Civil Grand Jury Report Seamless Senior Services Initiative Attempts to Coordinate 20 Agencies More than 20 County departments and agencies provide services to seniors and as a result of the large and growing elderly population in Los Angeles County, the County Chief Executive Officer launched the Seamless Senior Services (S3) Initiative in April