Elder Abuse - The Perfect Storm*

Elder abuse reporting has been rising and will probably increase because of a projected expansion in the population partially due to an influx of baby boomers. Response: Agrees with the finding.

Increased oversight would improve coordination and communication among county agencies and departments. Response: Disagrees wholly with the finding. The Adult Mental Health Services (Health Care Agency), the Adult Protective Services (Social Services Agency), and the Office on Aging (OC Community Resources) have developed multiple venues which provide opportunities for coordination and communication. Adult Protective Services (APS), Adult Mental Health Services, and the Office on Aging routinely participate in a variety of Agency meetings, seminars, educational presentations, and community meetings regarding Older Adults. These include: The Elder Abuse Forensic Center which is coordinated by University California Irvine (UCI) and APS meets weekly and has regular representation from Anaheim Family Justice Center, Community Services Program, OC Public Guardian, Office on Aging, Adult Mental Health Services, Legal Aid, OC Sheriff, UCI MD and Psychologist, District Attorney, Human Options, and In Home Supportive Services. The Financial Abuse Services Team (FAST) meets monthly and is coordinated by Council on Aging and is attended by Adult Mental Health Services, Office on Aging, APS, Federal Bureau of Investigation, Social Security Administration, Elder Law Attorneys, Bankers, Real Estate Agents, Law Enforcement, fiduciary, and ombudsmen. Each meeting includes an educational presentation by a professional and case presentation by APS. Older Adult Services holds a monthly meeting that is attended by APS, Health Care Agency Older Adult Services and representatives from the various committees serving older adults from that program. The Elder Death Review Team meets quarterly and is attended by the Coroner, Law Enforcement, District Attorney, UCI Medical Director, Adult Mental Health Services and APS. This provides an opportunity to discuss deaths that could have been prevented and how help could have been provided with the intent of educating team members. The Family Violence Committee meets quarterly at Superior Court and is currently • chaired by Judge Hubbard. • The Elder Abuse and Education Committee provides monthly brown bag educational trainings. It is attended by representatives from various groups dealing with family violence including shelters in Orange County. The Ageless Alliance meets monthly and is a grass-roots movement connecting . people of all groups to identify, prevent, and eliminate elder abuse. APS is actively involved as is Office on Aging and other partners. OC Task Force on Hoarding meets monthly and is attended by APS, Office on Aging, Health Care Agency Older Adult Services, Mental Health Association, Council on Aging, City Code Enforcement and private businesses. Mental Health Board Older Adult Committee meets bi-monthly and is attended by APS, Office on Aging, Health Care Agency Older Adult Services, Irvine Senior Services and representatives from Kaiser and Hoag hospitals. Adult Mental Health within the Health Care Agency actively coordinates care and planning of Older Adult services at every level. At a program and interagency level, staff members routinely coordinate client care with APS, Adult Outpatient Mental Health Clinics, Public Health programs, community senior centers, private Health Care providers including Kaiser and St. Anselms Cross Cultural Community Center, Prevention and Intervention, CalOptima, Office on Aging, and Council on Aging. These close community relationships are important in creating an integrated system of care that is readily accessible to Older Adults in Orange County. Through increased collaboration, APS has become more aware of the Mental Health criteria and reduced the duplication of efforts. Administratively, in 2008, Adult Mental Health consolidated Adult Outpatient Mental Health Clinics and Older Adult Services under one manager. As a result, we have seen an increase in referrals from the Adult Outpatient Clinics to Older Adult Services which indicates an increase in access to specialty services for Older Adults. Public Health and Behavioral Health share in the development and implementation of the Senior Health Outreach and Prevention Program (SHOPP), utilizing staff from Public Health and Behavioral Health. These individuals are co-located and routinely communicate regarding cases. This collaborative effort reduces duplication of services in that Public Health provides medical expertise and Behavioral Health provides mental health expertise. Jointly, they provide a thorough and integrated approach to services. In compliance with the California Department of Aging requirements, The Office on Aging Information and Assistance call center is staffed with trained and caring Information Specialists who are mandated reporters for cases of elder and dependent adult abuse or neglect. In FY 2011-12, the Office on Aging call center made 942 referrals to APS and 97 referrals to the Ombudsman program. As mandated reporters, Information Specialists receive a confirmation letter from APS on all elder abuse reports that are reported by the Office on Aging. Consistent with program confidentiality requirements across the State, the Office on Aging is not notified of results regarding specific cases once reported to APS. The Office on Aging coordinates the following efforts regarding elder abuse awareness: A shared toll free 800 phone line between APS and the Office on Aging allows callers to learn more about resources available in the community when contacting APS. The Office on Aging provides funding for the Ombudsman program and the FAST • 1 program through a contract with the Council on Aging. The Office on Aging partners with members of the Board of Supervisors to co-host Senior Summits and other community education forums which feature keynote speakers such as Dr. Laura Mosqueda and Dr. Kerry Burnight who are nationally recognized for their work on elder abuse. The Office on Aging toll free 800 number is used for the Ageless Alliance elder abuse awareness campaign. Office on Aging staff participates in monthly Ageless Alliance meetings facilitated by Dr. Kerry Burnight with the UCI Center of Excellence on Elder Abuse and Neglect.

The computer system in the Public Guardian's Office has been "inadequate for its intended use" for many years impacting the ability of the Public Guardian to provide documentation in areas of elder abuse. Response: Disagrees partially with the finding. The OC Public Guardian computer operating system is outdated and requires updating to integrate the banking and asset management component to comply with new formats in the court accounting document. The County awarded a contract to a software company to update the program; however, the contract was terminated for cause. A Request for Proposal will be released in February 2013 to update the OC Public Guardian computer system. The OC Public Guardian computer system lacks a field to identify the reason for sending a probate referral to the OC Public Guardian. This is currently tracked manually to identify the number of referrals where there are allegations of elder abuse. The OC Public Guardian investigates the need for a probate conservatorship and will seek appointment over incapacitated individuals who are at risk of being abused or who are victims of elder abuse.

A more definitive study is necessary to address four specific concerns within the area of elder abuse: Α. Oversight over coordination and communication between agencies; В. Outreach and communication to the general public; C. Review of law enforcement and prosecution; D. Effective Information Technology to manage data flow. Response: Disagrees wholly with the finding. A study to address communication, law enforcement and data management flow regarding elder abuse is unnecessary as these areas are already addressed through Adult Mental Health Services, APS, the Office on Aging and the OC Public Guardian. The Adult Mental Health Services, APS, the Office on Aging and the OC Public Guardian have developed multiple venues and participate in a variety of Agency meetings, seminars, educational presentations, and community meetings which provide opportunities for coordination and communication among county departments as well as providing outreach to the general public. + The OC Public Guardian receives referrals from APS and other community sources to investigate whether or not an individual meets the criteria for a probate conservatorship, pursuant to California Probate Section 1801. If a conservatorship is warranted, the OC Public Guardian will only petition for appointment. Should the investigator determine a conservatorship is necessary, a letter is sent to the referring party indicating the disposition of the investigation. Individuals referred to the OC Public Guardian may be victims of elder abuse. If the referral was received from APS, elder abuse has already been reported. In cases originating from a community source and the investigating deputy determines the referred individual is an elder abuse victim, the OC Public Guardian's investigator reports the incident to both APS and the local police department. Once the investigator reports elder abuse to the hotline, the OC Public Guardian's office takes no further action to coordinate and monitor the investigation with APS, but proceeds with its own process to investigate the need for conservatorship. County Executive Office/Information Technology along with OC Public Guardian are currently reviewing the business processes in order to conduct a Request for Proposal to be released in February 2013 for replacement of the current OC Public Guardian computer system. Responses to Recommendation R.1, R.2, R.3 and R.4