Seniors & Aging

Retiring Sacramento County aging chief says growing senior population poses big challenges

As part of a Sacramento County program that assists seniors in their homes, JoJo Gilles, 85, at left, drives Mary Modie, 71, to places she needs to go including grocery shopping at the Safeway on Alhambra Boulevard in Sacramento on Friday, Feb. 26, 2016.
As part of a Sacramento County program that assists seniors in their homes, JoJo Gilles, 85, at left, drives Mary Modie, 71, to places she needs to go including grocery shopping at the Safeway on Alhambra Boulevard in Sacramento on Friday, Feb. 26, 2016.

When Debra Morrow took a job in late 1998 to manage services for elderly and dependent adults in Sacramento County, she had 200 employees and an annual budget of $26 million to serve a senior population of 130,000.

By the time she retired March 4, the county’s Division of Senior and Adult Services had 322 employees and an annual budget of $35 million – and the senior population had grown to over 200,000. (She was replaced by Debbi Thomson, the county’s former manager of In-Home Supportive Services.)

The number of seniors in Sacramento County is projected to hit 235,000 by 2020 and top 330,000 by 2030, according to the state Department of Finance.

The division Morrow ran for 17 years includes In-Home Supportive Services, Adult Protective Services and the Office of the Public Guardian/Conservator.

These programs help seniors and dependent adults live safely in their own homes. Adult Protective Services investigates allegations of abuse or neglect, and the Public Guardian manages the affairs of people who die without a will or known relatives, minors who inherit estates and individuals under court supervision. In 2014, Morrow moved volunteer services into the mix from another department because it serves mostly seniors.

A social worker with a degree in criminal justice, Morrow formerly worked with crime victims in the Sacramento County District Attorney’s Office. She offered perspective on her tenure as she headed into retirement at age 61.

Q: Why did you take the job?

A: It seemed like a good fit.

I developed an interest in seniors while working in the DA’s Office, and one case stood out: A 4-foot, elderly woman who was cognitively impaired and had a thing for clean cloth of any kind. She would go to thrift stores to buy clothes she could bleach.

A 21-year-old raped her in her apartment. Prosecution did not go forward – even though the suspect’s identification fell out of his wallet onto the floor of her apartment – because the victim would not talk about what happened.

What struck me was her resilience. She had a cognitive deficit, but built a life for herself that continued, even after the rape.

Q: How much has the need for services grown since then?

A: Total intakes at Adult Protective Services went from 2,014 in 1999 to 4,243 in 2015. In-Home Supportive Services cases went from 12,000 to 24,000 – and there are about 800 new applications a month. Public Guardian cases dropped from almost 800 in 1999 to a little over 500 in 2015 because the criteria changed.

Q: Have the kinds of cases changed over the years?

A: We work with seniors 65 and over and dependent adults ages 18 to 64. Because of medical advances, people with disabling conditions live longer. That’s good, but it presents challenges. Elderly parents generally care for (dependent adults) in their own homes. They used to outlive the child, but that’s not always the case any more. In 1999, our caseload for In-Home Supportive Services was 60/40, seniors to dependent adults. Now, it’s pretty even.

Q: What about financial abuse and scams?

A: Financial abuse is largely by family members, but stranger scams are growing, and the stakes are higher. For the first six months of 2015, confirmed losses after investigation were $4,305,178. Fifty-nine percent of that amount – $2.5 million – resulted from scams by strangers.

We do a fairly good job stopping the flow of money going out. Unfortunately, getting it back is harder. It’s usually gone.

Q: Critics claim elder abuse is increasing and Sacramento County is not doing enough. What is your response?

A: One of the difficulties for APS is that people can refuse services. We need to honor people as they age and not make assumptions regarding disabilities.

It’s also important to remember there may be a resolution the public doesn’t know about. Privacy rights prohibit us from disclosing any information to the public.

We do not investigate abuse in long-term care facilities. That is out of our jurisdiction.

Q: Your budget didn’t grow at the same pace as the population or caseload. Aside from overall tightness due to the recession, why is that?

A: There’s a lack of interest in this population. Private industry is now becoming savvy to the senior population in areas like home care, but the annual statewide budget for staff training for Adult Protective Services is less than $100,000, while over $1 million is spent annually on staff training to protect vulnerable children.

At best, this suggests ignorance. At worst, it’s disinterest.

In the business we’re in, most people don’t pay attention until they’re in crisis. We offer services so they can stay in their own homes as long as possible, but denial sets in and pushes us into situations we don’t want to be in.

Q: Do you have an example where more staff training would have been helpful?

A: APS investigated a case in which a woman over 90 was sending tens of thousands of dollars to overseas lottery scams. But she was still working, seemed to have high mental function – and declined services.

This is an example of an individual who could manage every aspect of her life, but could not properly manage her finances.

Recent dementia research shows that, in some individuals, the inability to manage finances precedes the more obvious signs of mental impairment. This information and training for APS social workers is essential to their ability to prevent and intervene in (these) situations.

Q: What challenges lie ahead?

A: One of the things we worry about is the “oldest of the old,” which is a growing community. We look at seniors 65 to 75 as old, 75-85 as older old and over 85 as the oldest of the old. Seniors bristle at that – I probably will when I’m that age – but those 85 and above are the fastest growing.

The good news is we are living longer. The bad news is by the time we reach 85, half of us will be demented.

Q: What is the senior companion program?

A: Low-income seniors are paid a stipend to work with another low-income senior who, often, is homebound. They go to lunch, go grocery shopping or other activities. The goal is to make connections so clients are less isolated.

All volunteers are low income. The county pays an untaxed stipend of $2.65 an hour plus 40 cents per mile for gas. Volunteers must commit to 15 hours a week and usually have three or four clients.