Frequent Flyers Need More

May 16, 2018 | Jennifer Cotter

Older Asian Woman

Frequent flyers, super utilizers, returners, hot spotters—these are some of the terms used to describe the phenomenon of recurrent use of public or social services. In other industries, these terms may suggest additional services, incentives, seat upgrades, and free drinks. In public and social services, these titles represent high costs and complex needs and come at a financial and ethical consequence to public dollars and safety net services. 

The health care field has received a lot of attention over the past decade for their successful attempts to identify high-frequency emergency department users and provide intensive supports and case management services in between medical care appointments. This approach typically includes home visits and phone calls to support and connect patients to services and resources that address the complications that could land them back in the hospital. Several studies have shown that this approach—more intensive services for a longer period for high-frequency users—reduces high-cost health care utilization and improves health outcomes for these patients. 

Adult protective services (APS) departments and programs around the country vary; however, most are structured to conduct an investigation, stabilize the client, and close the case. In some ways, this is similar to a traditional emergency department approach to admit, treat, and discharge. Also similar is that a small percentage of these clients will have another incident of maltreatment or self-neglect in the near future, bringing them back to the attention of APS. 

I have been part of numerous meetings with APS departments where the suggestion of targeting extended, intensive case management services to the high-risk clients who are likely to return was met with a response citing limited department resources and complicated needs of older and aging clients. These limitations do exist, and they are the unfortunate reality of APS funding and services for now. How can we, within the current restraints, meet the needs of this vulnerable population—especially those high-risk, complicated frequent flyers? Maybe it’s time to think differently about how existing resources are allocated by targeting more time, attention, and oversight to older and vulnerable adults whose risk of recurrence is greater. 

APS departments are responsible for remedying the complicated situations and complex needs of vulnerable adults without sufficient budget and resources. Given what we have learned from the medical world, let’s start thinking differently about how we deliver services to the high-risk, frequent flyers of APS. Let’s do better at preventing recurrence and stopping the revolving door for our older, aging, and vulnerable population.

Jennifer CotterJennifer Cotter is an associate director at NCCD, focusing on the Structured Decision Making® system for child welfare and adult protective services. 

This is the third blog in a series addressing adult protection. To read the whole series, click here.