Sacramento County's elder population vulnerable to abuse

As Sacramento County’s senior population surges, so do instances of elder abuse—both physical and financial. That was the message delivered last week by the county’s Elder Death Review Team, a collection of 25 law enforcement, social work and health personnel at the state and local levels.

Committee chairman Paul Durenberger, who doubles as an assistant chief deputy with the district attorney’s office, presented his team’s annual report to the board of supervisors on April 7. The goal is to protect a 65-and-older population that made up 11.6 percent of the county’s total population in 2013.

According to the report, county Adult Protective Services received 1,324 allegations of financial abuse last year, up 43 percent from 2010, but down slightly from the year before. “The financial abuse seems to almost run rampant,” Durenberger told supervisors. “It happens in almost every physical abuse case that we see.”

That overlap wasn’t the only commonality. While nearly half of the 24 elder deaths the team reviewed between 2012 and 2014 were the result of natural causes, troubling themes emerged in the cases where something went wrong.

Nearly 60 percent of the cases studied involved seniors with dementia or cognitive impairment, while 40 percent of abusers were the adult children of the victims. Thirty-five percent of abusers were termed “overwhelmed caregivers,” while 29 percent were said to be dependent on the victims for financial or housing support. Poverty was also a recurring issue for victims.

“There was a substantial portion of this group that was at the poverty line or hovering around the poverty line,” Durenberger said.

Using five case studies as illustrations, the team explored recurring problems that involved overwhelmed caregivers contending with reluctant parents, a lack of communication between involved agencies, and hospitals and care facilities that didn’t always perform up to snuff.

In one, an 86-year-old woman experiencing dementia or cognitive impairment died after being admitted to a hospital with brain bleeding, a prolapsed uterus and bruises. Hospital staff suspected her adult child caregiver of abuse. Despite four previous referrals to Adult Protective Services for alleged neglect, no autopsy was done and the sheriff’s department didn’t file a report.

While Durenberger said that was the only case “where law enforcement dropped the ball,” the system as a whole failed pretty regularly. In fact, “system failure” and “inconclusive evidence”—a byproduct of system failure—were cited in 34 percent of the elder death cases the team reviewed. In one, a 99-year-old woman was brought to a hospital emaciated and with bed sores so severe they couldn’t be operated on. Investigators determined the woman’s adult child caregiver was following the limited instructions of a doctor who had been sanctioned multiple times by the state Department of Health Care Services.

“That’s a flag,” responded Supervisor Don Nottoli. “Are there other things that we can do to help make this system not fail as many folks as it has in the past?”

Durenberger’s team had its recommendations, some of which will be easier to implement than others. Increased training for first responders is already in the works, so that there’s more linkage between the various agencies that brush up against these issues. The county can also mandate that law enforcement is notified when an accused abuser is released following a psychological evaluation at a hospital, known as a 5150 hold.

Mental illness is common in violent abusers, the report states. In some cases, law enforcement picks up someone for an alleged abuse, discovers that they may be a danger to themselves or others, and brings them to the hospital for a psychological evaluation. While people can be held for 72 hours, sometimes they’re released within a few hours without anyone being notified.

In at least one current homicide case, an adult son returned home after being released from a 5150 hold and allegedly killed his elderly mother, the report states.

While law enforcement has the ability to offer protective restraining orders to abused seniors, they don’t always do so when they’ve brought a suspect in for a mental health evaluation. The report recommends changing that as well.

Another gap concerns skilled nursing facilities that don’t report suspicious deaths to authorities. Durenberger said doctors at these facilities sign death certificates and themselves declare the causes of death. One of the problems with this practice is that patients are sometimes brought to these facilities because of prior abuse that staff isn’t aware of due to privacy laws, and that may underlie the deaths.

“With the doctors simply signing off on the death certificate, it closes off many avenues of investigation,” Durenberger said.

His team recommended that nursing facilities operating within the county be required to notify Adult Protective Services upon a patient’s death, which could require legislation to enforce.

“That ought to be the law,” Nottoli agreed.

County executive officer Brad Hudson said staff would return with recommendations for the board to consider after consulting with county health officials.