A senior Alaskan died of hypothermia on her own during the winter of 2021 when concerned neighbors had reported the deterioration of the elderly’s situation several times to state social service personnel.
According to the report released on Thursday by the state Ombudsman.
“We discovered numerous opportunities to help vulnerable adults that were not taken advantage of,” Alaska State Ombudsman Kate Burkhart said.
An investigation that lasted for nearly three years by the Burkhart’s office that is charged with looking into administrative complaints made regarding state-run agencies concluded it was found that Adult Protective Services acted unreasonably and inefficiently by denying the older person’s concerns and not assisting by providing support prior to their demise.
In the report, which merely notes that the elder was a resident of an Alaska community that is cold in winter months, the following occurred:
In January 2020, neighbours were worried that the elderly had no heat at the house, and had not seen them in several days.
An animal rescue organisation was responsible for paying the elder’s electric bill. Even though the elder was unable to more drive, their vehicle had a use: it was a source for warmth.
The neighbor reported the incident for Adult Protective Services. The screener who received the report identified it as a priority three out of four and required an answer within 10 working days.
One month later, the older person was no longer able to walk. Their power was off. They had no water running. The house was filled with possessions. The smell that came from the waste of animals was unavoidable.
The neighbor called Adult Protective Services again.
It would take another month – march 2020 – until the state caseworker walked in at the door. And another month before a record of the visit was incorporated into the agency’s files.
A year later the elder was dead from hypothermia.
The concerns raised by Adult Protective Services raise larger concerns about the capacity of Alaska’s state government assist the state’s older citizens according to Burkhart the state’s Ombudsman. These questions will become more urgent in the coming years Burkhart said.
By 2022, nearly one fifth of Alaska’s inhabitants is older than 60. The number of people who are over 70 has almost tripled since 2010. In 2050, the number of Alaskans aged 65 and over is predicted to increase by 30 percent. The population of working age is projected to increase by 2percent.
“We’ve been talking often about”our population is getting older. Let’s prepare to accommodate that in the future,'” Burkhart said. “Are we prepared to meet their requirements? I’m not sure.”
Beyond the state’s capabilities ageing population poses the issue of values she added: In a country where autonomy for individuals is a fundamental element of the identity of a person When should the state intervene to shield the individual from self-defence?
An official government web site that is dedicated to the Adult Protective Services program puts the situation in this manner: “Freedom is more important than security. A person is free to choose to be in danger or self-destruct, provided they have the ability to make a decision and does not cause harm to anyone else and does not commit any crime.”
According to the report of the Ombudsman in the report, when the caseworker came to visit in March, the power and heating were turned on even though the home was filthy and suffocated with animal excrement. Local taxi companies were unable to take the elderly due to the smell.
The caseworker inquired if the elderly person would be interested in making the move to an assisted living center. The elder was not interested at the moment. They were reluctant to let go of their animals. However, the elder told them they should think about selling their land.
Adult Protective Services outlines its policies through its manual of policies that the office “provides support and protection services to Alaskans as part of the respecting the individual’s rights to refuse service and make their own decisions regarding the use and use of the services.”
Therefore, people who are believed to that they are able to make their own decisions and are aware of the implications of their choices – need to agree before caseworkers can assist them. If adults aren’t able decide for themselves, Adult Protective Services is mandated to pick the most flexible option that is available, for example, an attorney’s power of attorneys instead of a court-appointed guardian or conservator.
While the caseworker was able to find evidence that the elderly person had suffered “self-neglect,” as the report states the caseworker decided that the elderly person didn’t meet the requirements for more intense assistance without consent. In the end, they were accustomed to seeking assistance from local organizations as well as neighbours. The caseworker ended the investigation.
In October of 2020 the roof had caved into. A door was missing. There was no heating or running water. The house was sold, but the older was living there.
A neighbor reached out to Adult Protective Services again, concerned that the senior might die from freezing. The screener once again identified the case as Priority 3.
“Again, APS classified a report about a disabled senior who is at risk of being frozen as low priority,” the report states.
A caseworker contacted the office within a week. The elder informed the caseworker that they could get food and had bought some new heaters. The elder said that even though the property was sold, they did not have funds to purchase a new home to live in, and they had fallen victim to a scam on the internet.
As per the investigation the caseworker was not able to remember if the scam was reported to the police, but the notes from the worker “indicated the fact that they urged an adult in the report of the fraud the scam to Facebook.”
In a subsequent telephone conference with the case worker, as well as an agent from the Real Estate industry who assisted in selling the property the elder said they might transfer his Permanent Fund dividend to a family member. “The APS Worker documented that they believed this might be linked to another online fraud,” the report says.
The caseworker discussed financial management with the senior, but decided not to seek appointment of a guardian or conservator against their wishes, believing that the elder was able to make decisions on their own. In the end, the person in charge was searching for someone in the family to sign a the power of attorney, which is an arrangement that is less restrictive.
It took more than four months before the adult finally gave the caseworker with the correct number, per the report However, the family member was quick to accept.
Then, in March the food delivery service demanded a welfare inspection in the event that the senior didn’t have their food for three days. In a conversation with state troopers prior to the welfare assessment the caseworker “expressed worry that the adult might be in danger of the suicide risk,” according to the report. The trooper located the elder in the home, and determined that the elderly person was not in danger and requested they contact their caseworker. The elder refused.
A few days after the family member informed the caseworker that the elder wasn’t responding to their calls. The family member explained that they were worried that the elder might not be able to consent to the arrangement of power of attorney.
The caseworker called their supervisor as well as a senior assistant attorney general, and informed them that they would request an emergency conservatorship that will be reviewed at the next court hearing within 72 hours.
The caseworker did not follow up. They informed the ombudsman’s office “they were juggling a huge caseload for the region, and didn’t receive the overtime they were entitled to,” according to the report. However, investigators did not find any evidence that the caseworker was requesting overtime.
A member of the community discovered the deceased senior on March 31, 2021. According to the State Medical Examiner identified the cause of death as hypothermia.
The case was concluded after eight days. Even though the adult died by himself, from hypothermia, in a house that was collapsing and a roof collapsed, as well as the State trooper called trash piles up to four feet, Adult Protective Services maintained that the senior, prior to their death, was able to seek assistance and therefore was not an “vulnerable” adults.
The report of Burkhart contained eight recommendations ranging from limit on caseloads to the introduction of new staff.
The department’s Division of Senior and Disabilities Services that manages Adult Protective Services, has completely accepted seven of eight suggestions. It also accepted a plan to provide more intense training for its screeners as well as caseworkers as well as to create “multidisciplinary teams” comprised of experts who will review complicated cases. This approach which has proven successful in other contexts, as per research that are cited within the report. The report also suggested specific guidelines for reporting suspected crimes police.
The report of the Ombudsman also suggests three new jobs including an administrative assistant as well as an quality assurance manager, to free up time for the senior staff as well as the addition of a supervisor.
As the state continues to grapple with the effects of an ongoing shortage of staff State officials have said it’s hard or impossible to follow all the recommendations in the report.
The division refused to follow the ombudsman’s suggestion to establish and follow an acceptable limit on how many cases that are assigned to each employee.
In 2022, the administration estimated that each caseworker handled 50-70 cases, which is just a bit larger than the 26-to 50-case average found in the majority of states, according to the report of the ombudsman. The director of Senior and Disabilities Services told the ombudsman implementing this recommendation could be challenging.
“Since the year 2020 APS experienced a turnover of 50% annually which has led to staff shortages. There are currently three positions within the department are not filled. With these constraints and the need for a reduction in worker assignments could not be practical,” division director Anthony Newman wrote to the Ombudsman. “We are not sure when we will have a full-time staff and when we can expect an increase in the number of staff.”
In light of the difficulties in the process of hiring, Newman said his division may consider delegating one staff member to help fulfill the recommendation for an additional supervisor.
In a letter to Alaska Public Media, the deputy director of the division, Lynne Keilman-Cruz, said she was not able to comment on the details of the report. However, she stated that the division took all recommendations with a seriousness.
“APS accepts these findings, and will be attempting to make modifications to address any shortcomings identified in the oversight of investigations. Adult Protective Services takes seriously any reports of harm and is committed to ensure the safety, health and wellbeing the most vulnerable people,” she said in an email.
One of the suggestions is more extensive than the addition of the hiring of new staff or training: it is recommended that Adult Protective Services rethink its purpose.
“The agency encourages independence for individuals and this is a value that many of us possess. Another one of our values is caring for our elders. There was a conflict between these values during this incident,” said Burkhart, the Ombudsman.
She claims that the agency’s strategy of prioritizing freedom over health or well-being was a sign that elders’ self-denial and hoarding was seen as a choice instead of a sign of mental health problems that were serious.
“Personal autonomy and freedom from excessive and unjustified government interference are valued by Alaskans. State government agencies shouldn’t restrict or violate the rights of an individual unless absolutely necessary to safeguard the individual from harming himself as well as others” The recommendation says. “However in the event that the rate at which increasing number of people age and the incidence of self-neglect that is severe continue to make challenging situations for APS as well, it might be a good time to reassess when and how the state safeguards vulnerable seniors from dying like the person in this instance did.”
