Negligence by Alaska’s Adult Protective Services led an elderly Alaskan to die of hypothermia, according to a state ombudsman report released Thursday.
The ombudsman found the Alaskan, who wasn’t identified in the report, died “alone, in squalor, of hypothermia” after Adult Protective Services, or APS, categorized reports about his condition from a concerned neighbor as “low priority level for review.” The categorization delayed action, despite reasons to believe the adult in question faced “significant health and safety risks.” The report didn’t name the community where the person died.
The Division of Seniors and Disability Services, in which APS is housed, agreed with the ombudsman’s findings, stating that the “case demonstrates the need for adequate staffing to ensure that APS has adequate oversight and ‘fail safe’ policies and procedures.”
However, despite the ombudsman’s finding that limiting the caseloads of APS workers could prevent such incidents in the future, the division said it would not be able to institute limits on the number of cases handled by each of its employees due to a staffing shortage that has impacted the division since 2020.
‘Asking for and receiving help’
The ombudsman’s findings involve a death that occurred nearly three years ago, in March 2021.
According to the report, the investigation began after an individual filed a complaint in May 2021 alleging that they had contacted APS — a state office charged with supporting vulnerable adults — to report concerns about their neighbor. The neighbor was found dead in their home two months earlier, and the neighbor alleged that APS “did not do enough to intervene and protect the vulnerable adult and prevent their death.”
The investigation found that APS had received multiple calls about the adult in question. In 2020, an APS caseworker received a report that the adult was unable to keep his home heated, and his home “was full of piles of belongings and animal urine and feces, and the roof was caving in.” The adult had multiple animals in their home, and declined to move to an assisted living facility during a meeting with an APS case worker “because they didn’t want to leave their animals.”
The APS worker concluded in early 2020 “that the adult was not vulnerable because they were used to asking for and receiving help from neighbors and community nonprofits.”
Later that year, an APS worker again classified “a report of a disabled elder at risk of freezing” as low priority, despite the fact that the adult was living in a dilapidated home with no heat.
The adult sold his home in 2020 but “had been scammed out of the money by a person they met on the internet.” Despite learning of the scam, the APS worker “said they did not recall” whether they had reported the scam to law enforcement.
The APS worker did not pursue a conservator or guardianship for the adult at the time because the adult “had decision-making capacity.” Nearly four months later, the APS worker spoke with a family member of the adult, who agreed to a power of attorney arrangement, which is less restrictive than a guardianship or conservatorship.
In March 2021, a state trooper made a welfare check because the adult had not picked up their food deliveries for three days. Two days after the welfare check, the APS worker contacted an attorney in the Department of Law to discuss a conservatorship for the adult. But the worker did not submit the necessary information to initiate the process. The worker later cited their “large caseload” in explaining why the information wasn’t filed.
The adult was found dead in their home on March 31, 2021. The adult was found by a community volunteer. The cause of death was hypothermia, according to the state medical examiner.
State troopers who responded to the home found that the electricity was not functioning when the adult died.
The APS worker closed the investigation of the case a week after the adult was found dead, after determining that the adult “did not meet the APS definition of ‘vulnerable’ because they were able to seek help without assistance.”
‘Freedom is more important than safety’
The ombudsman made several recommendations to APS in response to the investigation. The division accepted most of them, with some caveats.
APS management estimated that in 2022, APS workers carried a caseload of between 50-70 cases. According to a national survey, Alaska’s caseloads are slightly higher than typical. In 21 states, cases per worker were between 26-50.
The ombudsman recommended that APS limit the allowed caseload per worker.
“Failure to limit the number of cases assigned to each worker may result in serious risks to the APS system’s efficiency and efficacy,” the ombudsman said.
But the division responded saying several factors made it “difficult to implement” the recommendation.
According to the division, APS has 11 permanent investigators, and receives 7,000 reports of harm every year, resulting in roughly 2,000 investigations. The division said it currently has three vacant positions and has experienced staff shortages since 2020.
“Given these challenges, limiting the number of case assignments to workers would not be feasible. We are unsure when we will be fully staffed and when we will see a stabilization in staffing,” the division stated.
The ombudsman also recommended that APS implement regional multidisciplinary teams to handle cases in partnership with law enforcement, tribal governments, district attorneys, mental health professionals and other community resources.
The division said in response that it would work to create multidisciplinary teams, but the timing of their creation “is unknown due to staff turnover, vacancies, training, and high-priority needs.”
The Ombudsman recommended that APS “should train screeners so they are able to make well-informed, documented, and unbiased screening decisions.”
In response to the recommendation, the division said that as of last year, APS screeners receive onboarding training through the National Adult Protective Services Training Center.
The ombudsman said that despite the changes implemented last year “there are still issues with how reports are screened.”
The division said it would require additional state funding to create a permanent position to oversee staff training. Such a position is currently funded by a temporary grant from the Administration for Community Living.
The ombudsman recommended that the division seek funding for a new administrator position to help implement the regional teams; a new manager position to oversee case investigations; and a quality assurance manager position. None of the positions were included in the governor’s proposed budget for the coming fiscal year, which was released last month. The division said it would consider rededicating one of its case worker positions to serve as manager.
The ombudsman’s recommendations also went to the core of APS’s mission. APS guiding principles currently state that “freedom is more important than safety. The person can choose to live in harm or even self-destructively provided that he or she has the decision-making capacity to choose, does not harm others, and commits no crime.”
The ombudsman found that “it may be time to revisit when and how the state protects vulnerable elders from dying the way this adult did,” including by recognizing that hoarding is a psychiatric disorder, rather than “a choice made by the elder.”
In response to questions directed at the division, including whether the APS case worker who handled the case in question is still employed by the division, Deputy Director of the division Lynne Keilman-Cruz said the division “is not able to discuss the specific circumstances regarding the investigation referenced in the Ombudsman’s report.”
“APS acknowledges the findings and is working to implement changes to address any deficiencies found in regard to the oversight of investigation processes. Adult Protective Services takes seriously all reports of harm and works diligently to ensure the health, safety, and welfare of Alaska’s most vulnerable individuals,” Keilman-Cruz said in a written statement.