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The Uphill Battle To End Elderly Abuse

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 Bonnie Klem, supervisor of the investigation unit of Montgomery County Adult Protective Services, in her Rockville office.
Matt Bush
 Bonnie Klem, supervisor of the investigation unit of Montgomery County Adult Protective Services, in her Rockville office.

Bonnie Klem calls her Adult Protective Services (APS) office in Rockville "chaotic." It's full of folders and binders stuffed with papers detailing hundreds of cases of alleged abuse or neglect. But despite that chaos and the grim contents of those folders, Klem is endlessly upbeat.

"What we have to do is walk into somebody's house and somehow convince them that we are really good people," she says. "We really want to help, and we just want to take some of their time. You have to be upbeat to get anything accomplished."

APS investigates reports alleging abuse, neglect and exploitation of frail elderly and disabled adults and intervenes to protect vulnerable adults who are at risk. Klem, who was a field investigator for 18 years, now oversees eight social workers handling suspected abuse cases in Montgomery County.

It's a difficult job with long hours, but the team is proud of the work they are doing,  says Klem.

Doing more with less

APS is made up of local agencies that investigate suspected abuse cases across the country. But the economic downturn has been tough on the agency.

Congress approved the first dedicated stream of federal funding for APS three years ago, but an appropriation of that money has not happened. Budget cuts at the local and state level have hit the agency hard, at a time when their workloads have increased exponentially.

Klem says her office gets about 60 to 70 elder abuse cases a month. Her workers must make first contact with the person who is suspected of being abused or neglected. Klem says that is probably the most difficult part of the job.

APS workers can't be easily discouraged, and often must emulate police detectives searching for clues, she says.

Cases involving abuse by family members are often the toughest because the abused don't want to turn in their blood, and the family members suspected of abuse can be intimidating, Klem says.

In one case, a grandmother was being kept from her family, Klem says. When they visited the home with a nurse and a social worker, the son stood near the door. They asked him to stay out, but he refused, saying they couldn't make him, which is true. They couldn't force him to leave in order to talk to the abused grandmother alone.

In the past, both a nurse and a social worker would often go together to the scene of alleged abuse. 

"It was a wonderful system because with the elderly, almost always you're going to find some sort of medical problem," says Klem.

The nurse could spot signs of physical abuse, while the social worker could talk to the person's caregiver or family. But budget cuts ended that, and now the social worker usually goes alone, Klem says. 

"We're learning to cope with that now. But do we like it? No, it was something that was unique. But they could cut it out because it's not required that nurses go out on APS cases," Klem says.

Staying upbeat in tough situations

 Klem says she isn't crying though because her office is far better off than others nationwide. But she does worry about the the lack of standards for what should constitute an APS office. 

"Because there's no national standards or requirements attached to federal funding, it's easy to cut a program that is only state funded because you're not jeopardizing any other money," says Kathleen Quinn, the executive director of the National Adult Protective Services Association.

One county in California cut two-thirds of its APS investigators. In Georgia, lawmakers just approved a 20 percent cut to the state agency that funds and oversees APS. Such cuts come at a time when 87 percent of APS units nationwide report having increased workloads, according to Quinn.

"Some of those states have been cut repeatedly," she says. "So they were cut in 2008... then again in 2009... and then again in 2010."

Quinn adds some estimate that there are more than 5 million elder abuse victims in the United States, as opposed to 1.25 million victims of child abuse, a problem that has vastly more money and laws devoted to it.

Klem says the sad reality is that most of the time all they can do is stabilize the situation and return to do it again, if needed. She adds that despite only about 20 percent of their cases resulting in happy endings, it's still enough to make the job worthwhile.

"I always tell my staff, if you're going into somebody's house, you really are taking advantage of them," she says. "So, if you are going into somebody's house, give them something that they didn't have before. Like transportation means, medical needs, food, diapers."

But it all goes back to being upbeat, something Klem reminds her staff of each day in Rockville.

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