Arizona state lawmakers and stakeholders are considering recommendations from a recent auditor general’s report for changes to agencies that handle reports of abuse and neglect of vulnerable adults.
The House Ad Hoc Committee on Abuse and Neglect of Vulnerable Adults met Wednesday and heard from the auditor general’s office and three agencies involved in adult care.
In 2022, the Arizona auditor general was instructed to conduct an investigation into how state agencies handle these reports of abuse and neglect. The office contracted with LeCroy & Milligan Associates consulting firm to research the issue.
The report outlines three main gaps in Arizona’s care system: a lack of strategic direction, an unclear case management process and the need to better engage patients and families. The report suggests that state leaders establish and appoint members to a group that can establish a clear “strategic direction” for the state’s adult protective services system.
Three groups — the Arizona Department of Economic Security, Arizona Health Care Cost Containment System and the Arizona Department of Health Services — all handle cases of adult abuse and neglect.
LeCroy & Milligan Associates representative Michel Lahti told the committee that Arizona’s agencies don’t work together cohesively enough.
“There’s no way to track service outcomes for a vulnerable adult that’s served by various agencies or entities,” he said.
All three groups sent representatives who said they agreed with the findings of the report.
The Adult Protective Services division under DES handles the bulk of abuse and neglect cases, but the Committee Chair Rep. Jennifer Longdon (D-Phoenix) is concerned that APS has no ability to manage cases.
“They don’t have the resources. Once they refer someone out they have no ability to follow up on that to see; has it been an adequate referral, is it being acted on? And that’s a problem,” she said.
The average caseload for APS investigators looking into potential instances of abuse and neglect has gone down since it hit a high during COVID-19. The agency finds that the smaller caseload ratios lead to better results all around.
A very low percentage of abuse and neglect cases are investigated and substantiated, meaning only a fraction of perpetrators are penalized.
“It’s hard to imagine that so many individuals are not being accountable for such an egregious situation,” committee member Christopher Rodriguez said.
Although DHS and AHCCCS undergo federal oversight, APS does not. Nor is it supervised by an independent state committee.
APS also doesn’t have the ability to investigate a case until a report is filed and they are asked to. They also don’t have the authority to give emergency protective orders or follow up on cases they’ve passed along.
Committee member Meghan Kramer said that money is the elephant in the room that will be needed to fill in gaps.
“If a caregiver can’t make much more than what you make as starting salary at McDonald’s, the quality is not going to be very high, and we’re not going to have enough bodies to fill these rolls. … If people are entitled to the services and they’re not getting them then they’re self neglecting or they’re being neglected,” Kramer said.
APS requested more funding to monitor the “status and client and services” as the report suggests.
The ad hoc committee began in 2019. It’s submitted several recommendations over the past few years which became law. Now, it’s likely that some of the report’s recommendations will appear as legislation in the upcoming legislative session.
“I think the recommendations that were made in the audit are all good, and I intend to encourage the speaker, the president of the senate and the governor to convene the workgroup that was suggested in the audit,” Longdon said after the hearing.
