June 24, 2013
June 24, 2013
Ohio has a growing elderly population in need of services, badly matched with declining resources for services and harsh cuts to local government. It is time to provide appropriate funding for this critical service to seniors.
Key Findings: Protecting Older Ohioans
In the 1960s, the United States began, as a nation, to better recognize that elderly Americans were vulnerable to neglect and abuse, and to establish ways of protecting the older members of our community. By providing good protection, we can reduce financial exploitation, health problems, hospitalization and suffering for older Ohioans. More importantly, such services can improve the quality of life for elderly citizens.
Ohio has mandated some forms of protective services for adults since the 1970s and the state enacted laws mandating local services in the early 1980s. State funding has been provided for adult protective services (APS) in some, but not all, years since then. In 2005, the 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.
Things have changed a little, but not all that much. When that report was issued, funding had dropped from $2.8 million in 1990 to $70,000 in 2003, and then vanished. Today, the Senate version of the pending two-year budget (House Bill 59) proposes funding at $500,000 each year.
Ohio counties provide protective services to the elderly and rely heavily on federal Social Services Block Grant (SSBG) funds to pay for these services. Funding for SSBG has declined, and the across-the-board federal spending cuts known as the sequester are taking additional funds from each county in the current year. Sequestration could further cut the SSBG for the next nine years. If we want older Ohioans to be well protected, it is essential that we begin providing adequate state-level funding, rather than relying on unstable and declining federal sources. State funding of between $11.5 and $18.4 million annually would ensure adequate staffing. As Ohio’s General Assembly makes final decisions over the budget for the next two years, the pressing needs of the most vulnerable Ohioans should not be forgotten.
In 2011, the Government Accountability Office’s study on elder justice highlighted that some research finds up to 14.1 percent of America’s non-institutionalized elderly experience abuse, and that states struggle to provide services. This is a tragic, preventable and expensive health threat to a vulnerable population. The number of reported cases likely dramatically understates the problem. The Ohio Department of Job and Family Services received 14,344 report of abuse, neglect and exploitation of adults over 60 in Ohio in 2012. The National Elder Abuse Incidence Study of 1998 estimated that for each reported case of elder abuse, five cases are unreported. A report done for the Health Policy Institute of Ohio estimated in 2010 that 90,000 to 115,000 of Ohio’s seniors experienced this health threat. If indeed abuse reaches 14.1 percent of non-institutionalized seniors, the number would be far higher than even 115,000. This is why such abuse is known as a ‘silent epidemic.’
In 1989, 9,132 incidents of abuse of elderly Ohioans were investigated; at that time, 630 caseworkers were employed in adult protective services in Ohio. In 2012, 14,344 such cases were reported. Although the number of caseworkers in adult protective services across Ohio’s 88 counties at present is not documented, it appears to be well below the level in 1989. An April 2013 report by the Center for Community Solutions surveyed 48 Ohio counties about their adult protective services, and found 114 workers serving the program in those counties. The number of people over 60 increased in Ohio between 1990 and 2012 by 26.3 percent, and incidents reported to protective services increased by 57 percent over about the same time period. Yet state funding specifically dedicated to adult protective services dropped, from $2.8 million in 1990 to a projected $500,000 for fiscal year 2015 – a decline of 82 percent.
Figure 1 shows state funding for the Adult Protective Services line item since 1990. Ohio passed legislation mandating these services in the early 1980s, yet did not provide funding until years later. Funding in the 1990s hovered between $2.5 million and $3 million annually. In fiscal year 2003, state funding for the specific line item that funds adult protective services ramped down and then ceased. A small budget line was restored in the 2008-09 biennial budget.
Protective services have long been understood as a government function in American tradition. Awareness of abused, neglected and exploited elderly Americans has grown over time. The 1961 White House Conference on Aging recommended “…that social agencies, legal aid and bar associations and the medical profession increase their cooperation and continue their study of ways to facilitate the provision of protective services to older people.” Many states passed laws, but it took federal funding to gain traction for implementation. In 1974, Title XX of the Social Security Act provided the Social Services Block Grant, which could be used for the protection of adults as well as children. Since then, neither specific legislation nor dedicated funding emerged for adult protection at the federal level, either. As a result, protective services for adults have competed with other pressing service needs for shrinking resources.
The 2000 survey of states conducted by the National Center on Elder Abuse found that on average (not weighted for population) state and local funding sources provided $4.607 million for adult protective services, and the Social Service Block Grant provided $2.987 million. In 2000, Ohio spent $2.7 million from state sources. Ohio, the 6th largest state in terms of senior population, will spend about $18.8 million from all sources in 2013; 2 percent was from state sources and 98 percent from federal sources (Figure 1).
Ohio’s use of SSBG funds differs from the national norm in that we are more reliant on the federal support and provide less state aid than typical. Ohio was the sixth largest state in terms of elder population, but had the fourth highest SSBG expenditures on adult protective services in 2009.
Table 1 shows – from a different source – the size of total state budgets for adult protective services in the states with the largest elderly populations in 2009 (the most recent year for which data is available). Ohio stands out for its reliance on federal funds.
Ohio’s reliance on SSBG is risky, as this source has lost 77 percent of its inflation-adjusted value since 1981. The federal sequester will take more than $2 million dollars from Ohio’s county social services in the current federal fiscal year, with nine more years of cuts looming. In 2012, the U.S. House of Representatives Ways and Means Committee voted to eliminate this block grant altogether.
Senior services, including adult protective services, can be funded from other state and local revenues in Ohio, but these ancillary sources are not dedicated to protective services; some are declining in the face of growing need, and competition for funds is strong. For example, seniors in 73 counties receive services funded with county, township or municipal senior services property tax levies. While these funds could be used for protective services, they rarely are; they are used for services seniors need, like transportation, meals on wheels, and other forms of nutritional aid. The elimination of tangible personal property and utility tax reimbursements in the current state budget has reduced funding to local senior services levies across the state by $9 million a year from the level of 2012. In addition, there are other state funds are available for a range of protective services – children, families, adults, community – but the state does not keep track of which category these funds are used for.
Little is known about staffing patterns across Ohio’s 88 counties. We know that only 39 of Ohio’s 88 counties have dedicated staffing for adult protective services, that funds for senior services are concentrated from the SSBG, a shrinking source, and that the Ohio elderly population is growing. How much should the state allocated for this service?
Table 2 looks at need for caseworkers from the perspective of staffing alone. It does not address the costs of facility, administration, travel, support and clerical staff and all of the other aspects of providing a service. Nor does it consider the cost of providing key elements of preventative action: training providers, outreach, monitoring of perpetrators, and provision of services. In Table 2, nationally accepted levels of caseworker staffing for adult protective services are applied to just the number of reports of incidents in 2012, and then to other estimates for this ‘silent epidemic,’ to understand the most basic level of staffing needed, and possible costs.
The first row gives annual figures, actual and estimated, of reports/incidents of elder abuse, neglect or exploitation in Ohio. The actual number of reports is given in the second column. The third and forth columns give the estimates calculated by the 2010 report “Family Violence in Ohio: Statewide Assessment:”column three contains the low estimate from that study and column four, the high estimate. Column five takes the assumptions of the National Elder Abuse Incidence study of 1998 (that there are five unreported cases for each reported case and applies it to the number of actual reported incidents in Ohio in 2012. The second row derives a monthly estimate of incidents – “cases” – that need staff attention dividing the annual figure by 12. The third row derives staffing needs by dividing the monthly incident figures by the nationally recommended APS caseload of 25 cases per month.
As mentioned, in the recent Center for Community Solutions survey responding counties identified about 114 caseworkers statewide working in Adult Protective Services. Yet almost 70 were in just three densely populated, urban counties.
Determining adequate staffing depends to some degree on how we measure the need, particularly given the underreporting of this problem. The fourth row of Table 2 shows the cost just of professional staff – caseworkers –based on median wage for a social worker in the state of Ohio, with 25 percent of wages added-on for benefits. The bottom line figure is understated because costs other than caseworker salaries are not included. The number of caseworkers needed statewide varies from about 50 to cover just reported cases, which are underreported, to nearly 400 if we use the Health Policy Institute of Ohio’s upper-bound estimate of cases.
Funding needs just for the professional salaries of the estimates in Table 2, excluding other costs, would then vary from about $2.3 million to cover just current reported cases to $18.4 million if we accept higher estimates. This is not out of line with state and local spending in other states.
The funding level being sought by the advocacy community in Ohio falls between levels shown in Table 2. Advocates for the elderly have recommended FY 2014-15 funding of $11 million in the pending state budget. This would provide a stable state funding base, reduce dependence on a shrinking federal source, and allow counties to better address the silent epidemic.
Ohio has a growing elderly population in need of services, badly matched with declining resources for services and harsh cuts to local government. Given the under-reporting, the growing need to implement some of the good recommendations of the family violence assessment study, and the amount of work involved, it is time to provide appropriate funding for this critical service to seniors.
 Attorney General Jim Petro, Ohio Elder Abuse Task Force Report, 2005 http://aging.ohio.gov/resources/publications/eatffinal.pdf, accessed June 20, 2013.
 Ron Acierno et al, “The National Elder Mistreatment Study,” (United States Department of Justice) 2009, cited in Government Accountability Office, “Elder Justice: Stronger Federal Leadership Could Enhance National Response to Elder Abuse,” March 2011 at http://www.gao.gov/new.items/d11208.pdf, accessed June 20, 2013.
 Government Accountability Office, “Elder Justice: National Strategy Needed to Combat Elderly Financial Exploitation,” November 2012 at http://www.gao.gov/assets/660/650074.pdf , accessed June 20, 2013.
 The National Elder Abuse Incidence Study. (1998). Washington, DC: National Center on Elder Abuse at http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf. Accessed June 20, 2013.
 Kenneth Steinman, “Family Violence in Ohio: Statewide Assessment Report,” Health Policy Institute of Ohio, October 29, 2010 at http://a5e8c023c8899218225edfa4b02e4d9734e01a28.gripelements.com/pdf/publications/ofvpp_state_report_-1.pdf . (Table 6. Estimated past?year prevalence (range) of abused, neglected and/or exploited seniors living in the community and living in long term care facilities, by county). Accessed June 20, 2013.
 Mike Payne, “Elder Abuse: An Unspeakable Shame,” In David Charlson (editor), Family Violence and Religion: An Interfaith Resource Guide, Volcano Press, 1995.
 Ohio Department of Job and Family Services, Adult Protective Services Fact Sheet for SFY 2012. Of 14,837 reported incidents in 2012, 14,344 were reports for elders: adults 60 years of age or older.
 Center for Community Solutions “Adult Protective Services: Opportunities for Savings through Economies of Scale,” April 2013 at http://www.communitysolutions.com/associations/13078/files/APSfinal4.11.13.pdf. Distribution of workers was highly uneven across counties, with 60 percent of workers concentrated in just three urban counties.
 National Adult Protective Services Association at http://www.napsa-now.org/about-napsa/history
 “The 2000 Survey of Adult Protective Services,” National Center on Elder Abuse at http://www.ncea.aoa.gov/Resources/Publication/docs/apsreport030703.pdf . Thirteen (13) states reported receiving an average of $2,987,648 from the Social Services Block Grant. Amounts ranged from $98,569 to $9,513,337. Thirty-nine states (39) did not indicate if funds from the Social Services Block Grant were available. Twenty five states indicated that they received money from state and local funding sources. The average amount received from state and local sources was $4,607,112. Responses ranged from $10,000 to $54,649,000.
 Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2012. Source: U.S. Census Bureau, Population Division; Release Date: June 2013.
 Data in this paragraph is taken from the United States Department of Health and Human Services, SSBG 2009 Annual report, Appendix F: Supplementary Data Tables, Table F-1 (SSBG Allocation and Expenditures by State, 2009) and Table F—7 (Percentage of State SSBG Expenditures by Service Category, 2009) at http://archive.acf.hhs.gov/programs/ocs/ssbg/reports/2009/appendixF/F1_0.html, accessed June 20, 2013.
 Indivar Dutta-Gupta, LaDonna Pavetti, and Ife Finch, “Eliminating Social Services Block Grant would weaken services for vulnerable children, adults and disabled,” Center for Budget and Policy Priorities, May 2012 at http://www.cbpp.org/cms/?fa=view&id=3765.
 Data received in an email from the Communications Office of the Ohio Department of Job and Family Services, June 3, 2013.
 Ohio Department of Aging website at http://aging.ohio.gov/information/seniorserviceslevies/.
 Estimated by Policy Matters Ohio for graphs used in the publication “Intensifying Impact: State Cuts to Locals Deepen,” Policy Matters Ohio, 2013 at http://www.policymattersohio.org/intensifying-impact.
 In an e-mail of May 16, 2013, the Communication Office of the Ohio Department of Job and Family Services stated: “Protective services for children and adults are two of many possible uses for 600533 [Child, Family, and Adult Community & Protective Services] and the budget does not break the total amount into specific allowable services.”
 Center for Community Solutions, Op.Cit.
 Steinman, Op.Cit.
 In 2010, this statewide assessment of family violence estimated up to 5.2 percent of Ohio elderly experience abuse, neglect or financial exploitation at the hands of a caregiver. The researchers estimated between 90,000 and 115,000 of Ohio seniors living in their own homes experienced such harm. This does not include people in nursing homes, and it does not include “self-neglect”, which occurs when people are harmed because they’re unable to care for themselves because of illness or infirmity.
 National Elder Abuse Survey, Op. Cit.
 United States GAO, 11-208, March 2011, Op.Cit.; The United States General Accountability Office reviewed four primary studies of elder abuse (Appendix, table A-X); in their 2011 report on Elder Justice, they cited the figure of 14.1 percent of non-institutionalized seniors as an estimate of abuse, neglect or financial exploitation.
 Marilyn Whalen, Caroline Lieske and Joanne Marlatt, “APS Compilation of workload studies and caseload data,” National Association of Adult Protective Services Administrators, 1997. A copy was e-mailed to Policy Matters Ohio by the National Adult Protective Services Association on May 13, 2013.
 Center for Community Solutions, Op.Cit.
 If we assume that 14.1 percent figure highlighted by the General Accountability Office in the Elder Justice Study of 2011 was correct, more than a thousand caseworkers would be needed.
 We have spoken with representatives of Advocates for Ohio’s Future and Ohio Adult Protective Services Coalition in writing this report.
 The Community Solutions report recommended creation of a coordinated Adult Protective Services system in Ohio and suggested that efficiencies could be gained from such coordination. That paper did not make a recommendation for funding levels but suggested the state could get buy on substantially less than what we are recommending here and what the advocacy community is requesting, in part because their recommendations were based only on currently reported cases. Given the careful documentation of the terrible underreporting of such cases, our recommendations reflect what experts believe to be more accurate estimates of elderly abuse and neglect.
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