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Reconciling the Rights of Vulnerable Adults and the Need for Services

May 6, 2012 | Kathleen Quinn, Director, National Adult Protective Services Association

Kathleen is the Director of the National Adult Protective Services Association (NAPSA), a nonprofit organization which provides the only national voice for Adult Protective Services programs, professionals and clients. She has 30 years’ experience in the family violence field, one decade in domestic violence at the state level in Illinois, and 20 years in elder abuse and adult protective services working for the State of Illinois.

Kathleen is the Director of the National Adult Protective Services Association (NAPSA), a nonprofit organization which provides the only national voice for Adult Protective Services programs, professionals and clients. She has 30 years’ experience in the family violence field, one decade in domestic violence at the state level in Illinois, and 20 years in elder abuse and adult protective services working for the State of Illinois.

Theodoric C. James, Jr., age 71, who worked in the White House from President Kennedy’s administration to President Obama’s, was found dead of heat exposure in his Washington, DC, home last summer, the Washington Post reported on August 13, 2011. The Post reported that this once meticulously groomed man, who had catalogued many thousands of White House documents over his decades-long career, was living in squalor, without heat or running water, dressed in the same clothes for well over two years.

Mr. James’ out-of-state family and a concerned neighbor tried repeatedly, over an extended period of time, to get help for him from numerous city agencies. A January 31 Washington Post article about the District’s Inspector General’s report on the case, states, “More than 70 D.C. employees tried to help James over a two-and-a-half-year period leading up to his death. Adult Protective Services (APS) went to his home at least 17 times, according to the report. Department of Mental Health employees visited at least nine times. Police and emergency crews responded several times as well.”

But Mr. James repeatedly refused assistance and cut himself off from his old friends and former White House colleagues. He was well-spoken and polite, and when interviewed could appear to be cognitively intact despite his dreadful living conditions.

The Inspector General’s report recommended that the District establish a database, so city agencies can know how many times each agency has responded to one individual. The report also recommended that the District consider rewriting its involuntary commitment laws to make them less vague and more helpful in situations such as Mr. James’. Furthermore, it suggested that APS consider drafting policies to make it possible for APS workers to directly petition for guardianship and/or conservatorship without having to go through the Office of the Attorney General as they did in this case. 

Mr. James’ case was a classic example of self-neglect, one which mirrors situations APS workers face every day. The issues raised by self-neglect go to the heart, and the complex difficulty, of APS work. Every case requires APS to balance itself on a very thin tightrope, weighing adults’ right to live their own lives and to make their own decisions (essentially the cherished American right to be left alone) with the moral and legal duty to intervene to protect adults who are clearly unable to protect their own health and well-being.

Despite recent improvements, the tools available to assess risk and cognitive capacity are not as yet effective as they need to be, and many APS programs do not have access to the most recent and well-researched tools available. In addition, as illustrated by Mr. James’ case, APS is often dependent on other agencies and systems to carry out necessary interventions such as guardianship.

The guiding principles set forth by the National Adult Protective Services Association (NAPSA) in its APS Code of Ethics are as follows:

  • Adults have the right to be safe.
  • Adults retain all their civil and constitutional rights, unless some of these rights have been restricted by court action.
  • Adults have the right to make decisions that do not conform with societal norms, as long as these decisions do not harm others.
  • Adults are presumed to have decision-making capacity unless a court adjudicates otherwise.
  • Adults have the right to accept or refuse services.

Obviously, these rights can conflict with one another, for example, the right to be safe vs. the right to accept or refuse services.

To ensure the best outcome for clients, APS investigators must be well trained, operate under well-designed program policies and procedures, have manageable caseloads, have adequate supervisor involvement in their decisions, work in cooperation with other agencies, and be held accountable for accurate and thorough case notes. They must also have the knowledgeable cooperation of other systems, including those of criminal and civil justice and health care, including public health.

The unfortunate fact of the matter currently is that state and local APS programs are struggling to attain and maintain high quality standards while their budgets and staff numbers have been slashed in jurisdiction after jurisdiction, at the very time the numbers of reports are soaring. The same is true of other community services as well. This reality means that the many Mr. James, who live in all of our communities, remain at high risk of failing health and even death.

Through the work of the Adult Protective Services Resource Center and its partner organizations, including NCCD, we strive to advocate for APS agencies and caseworkers on the frontlines in their ongoing efforts to help the thousands of vulnerable adults like Theodoric James. 

To learn about NCCD’s work in Adult Protective Services, please click here.