Reports of neglect, exploitation and abuse of older adults to a county hotline rose more than 30% in the last five years — a harbinger of what’s to come as Cuyahoga County’s population ages.

“To look at gradually where we’re headed with this and knowing that the population is only getting older here in our county … all these different things are things that need to be on the radar,” said Natasha Pietrocola, the director of the county’s Division of Senior and Adult Services. “And APS [Adult Protective Services] is not funded well. Just, period.”

The Adult Protective Services team at the county responds to confidential calls that come in about adults over the age of 60. The county is expecting close to 30% of its residents will be 60 by 2030. In 2021, that number hovered closer to 26%, according to the Center for Community Solutions. 

The county budgets about $5.4 million a year for adult protective services, Pietrocola said, of which a tiny fraction comes from the State of Ohio. It employs about 30 social service workers who take on cases. 

The most common type of report the county receives is for “self-neglect,” or the concern that an adult is not taking adequate care of themselves. That can show up in a number of ways, Pietrocola said: an inability to feed themselves, to follow a prescription regimen, to treat any injuries they have. In self-neglect situations, the department often finds adults who have dementia, mental health challenges or physical impairments that make it difficult to move or walk.  

Another quarter of the reports concern exploitation, accusations that someone has illegally or improperly used an older person’s money or resources. That can include outright theft. But it could also be more insidious. For example, a relative may try to keep an older person at home – instead of moving them to a nursing home – to maintain access to their home, pension or Social Security check, Pietrocola said.  

The department also receives complaints about neglect by caretakers and elder abuse – physical, emotional and sexual. In addition to older adults, it also responds to reports about younger people who have disabilities. 

Aside from the aging population, Pietrocola said she believes the growing number of reports is due to the residual effects of social isolation during the pandemic and the economic vulnerability of seniors. As inflation eats into their fixed incomes, they may forego various necessities, like medication, Pietrocola said. 

“They have to do a juggling act,” Pietrocola said. “So do they stop taking medication? Do they split their pills in half? Do they end up with a stroke because they didn’t take the full dose of the blood thinner they were supposed to take?”  

At the same time, more reports to Adult Protective Services isn’t necessarily a bad thing, she said. Pietrocola said it could mean more residents are aware of the elder abuse hotline and of the need to report concerns. The largest pool of people calling in concerns is professionals who are required by law to report abuse, like social workers in hospitals or doctors’ offices.

What happens when a call comes in?

A social worker with Adult Protective Services will visit, without prior warning, the adult about whom a report was made. 

Depending on the concern, a nurse may join the social worker. The team often brings the nurse when the concern involves an older person leaving a nursing home or hospital against medical advice, Pietrocola said. Other times, a person may have an exposed and infected wound that needs treatment, with which the nurse can assist.

Once a first visit is made, the social worker can establish what allegations are true and how to stop them. 

The department’s lighter interventions include connecting residents with resources to help them live on their own, like home-delivered meals or home health care. 

“We set up care plans. We get family involved, if there’s family that’s viable,” Pietrocola said. “We get outside providers involved.”

The department has a behavioral health unit made up of social workers who can screen whether a person has depression or other mental health challenges. If there are concerns a person has dementia, the team can connect the resident with local hospitals to get medically assessed. 

Some situations may require more serious interventions, though, Pietrocola said. That typically means involving the courts. For example, if an individual is not taking care of themself and is refusing to get screened for dementia, the APS team could seek a court order to get the person tested by a medical professional. The court can also freeze a person’s assets if the APS team has evidence that their client’s money and resources are being exploited. 

The most extreme outcome of a call to Adult Protective Services is moving the client into a guardianship. A guardianship is a legal process where a court deems someone unable to make personal or financial decisions for themselves. The court assigns a third party to make those decisions. These are often only sought after the team has tried all other options, Pietrocola said.

Who can make reports to APS? 

Anyone can make a report to the county’s Adult Protective Services team. But the state designates certain professionals as mandated reporters for elder abuse. 

That includes Ohio attorneys, nurses, real estate brokers, bank employees and financial planners. Employees of home health agencies and nursing homes are also mandated reporters. 

Several criteria must be met for Adult Protective Services to accept cases. The person of concern must: 

• Be age 60 or over (or age 18-59 with disabilities)
• Be impaired and/or disabled
• Have an allegation of abuse, neglect, self-neglect or exploitation
• Live in the community (not a licensed facility, like a nursing home or rehabilitation facility)

How to make a report:

• Hotline: 216-420-6700
• Ohio APS Online Elder Abuse Referral Portal