The Texas Tribune
HOUSTON – Charla Gilliam has her morning routine down pat, complete with her gospel music, sermons and reading case files for vulnerable older adults and disabled people she needs to see.
As an Adult Protective Services caseworker for the state, she has 40 or more cases of people who have been reported to the agency for potential abuse or neglect.
“You’re going to be praying to somebody when you go to these different places,” Gilliam said as she pulled into a driveway.
She was visiting the first home on her list. It’s a physical neglect case she has been preparing to close soon about a man in hospice care at home with his wife. APS received a call accusing the hospice company of purposely taking away the machine that helps him breathe. The machine was replaced but Gilliam was following up.
She has other people she’s watching out for: There’s the man whose family padlocked the refrigerator shut. There’s the man who became paralyzed after a suicide attempt. There’s the husband who took his wife with multiple sclerosis off his health insurance plan after finding out he wasn’t the father of their child.
“A lot of the time you just never know what you’re walking into,” Gilliam said.
The agency – which is part of the Texas Department of Family and Protective Services – is experiencing high caseworker turnover and caseloads as these staffers work through the emotional toll of supporting and providing services for older and disabled Texans. Caseworkers are also unhappy about workers at Child Protective Services – which is also part of the department – getting significant raises after high-profile scrutiny from media and state leaders.
As legislators head back to Austin for the 2019 legislative session in January, it’s unclear how much attention the agency focused on protecting vulnerable adults will receive.
“I do not want a client to die because we didn’t do our job and do it to the best of our ability,” said Kezeli Wold, associate commissioner for APS.
Caseworkers like Gilliam watch heartbreaking situations of older and disabled Texans not taking care of themselves, being hit, forgotten or financially exploited. That’s on top of job hazards like foul stenches, roaches, rats and bedbugs.
In fiscal year 2017, Adult Protective Services confirmed 51,314 cases of abuse, neglect or exploitation.
Anyone can confidentially report to the agency online or by phone if they suspect a person 65 years or older or an adult with disabilities is being abused, neglected or exploited.
While APS is often looked at as the Child Protective Services for adults, the two agencies differ. Both conduct investigations and provide services, but the adult agency doesn’t remove people from their homes like CPS does. Workers may connect clients to services like shelter, food, medication, transportation and assistance paying rent and utilities. But there’s nothing they can do when clients who are not dealing with memory or comprehension issues decline help. In addition, APS doesn’t keep track of deaths like the child welfare agency does.
Wold said he loses sleep thinking about what could happen to clients as turnover in his agency has continued.
In the first three quarters of the 2018 budget year, 17.4 percent of its workforce left the agency, according to a Texas Department of Family and Protective Services report released in July. The agency, which has 524 caseworkers statewide, projected it would lose 78 first-year workers before the end of the budget year. The fiscal year has ended, but the department doesn’t have new turnover numbers available.
“We’re relatively unstable,” Wold said. “When you have turnover in a complex job like APS, best case scenario you become inefficient, worse case scenario somebody makes a poor decision or somebody fails to identify a root cause or fails to identify a safety issue.”
Lots of turnover means caseworkers need to visit more people. There is no national standard for how many clients a caseworker should have. In fiscal year 2017, the average daily caseload for Texas caseworkers was 33.8, but went down to 30.9 the following year. The agency said in its most recent quarterly report that the workloads “remain higher than ideal” despite the numbers going down slightly.
The problems with high turnover and increased workloads are similar to what CPS was experiencing two years ago. At the time, the child welfare agency was making headlines over children sleeping in state offices, overworked caseworkers and some endangered children going unseen by workers. During the 2017 session, legislators made a sweeping overhaul of the program and right before that increased worker salaries by $12,000. Agency officials and child welfare advocates credit the raises for the decreased staff turnover and caseloads. In fiscal year 2016, CPS caseworker turnover was 25.3 percent. It dropped to 18.4 percent the following year.
But after the child welfare agency’s salary increases, APS saw a 24 percent uptick in turnover – and that number doesn’t include at least 27 workers who switched to Child Protective Services after the raises went into effect.
“Staff leaving APS places additional stress on the staff who remain at APS, as remaining staff work abandoned caseloads from peers who leave,” agency officials wrote in their budget request. “New hires are quickly faced with high caseloads due to the constant turnover, soon become stressed, and often quit before they have been with APS for a year.”
Gilliam said if she had to come into the job at the current starting pay, she wouldn’t have done it; the pay is not equal to the difficult work they do. Her annual salary is $52,045. A first-level caseworker typically makes $31,923, annually, according to The Texas Tribune’s Government Salary Explorer database.
“You kind of get treated like a stepchild,” she said. “You got to care about people to do this job.”
Wold and other agency officials are hoping legislators will approve their $17.8 million request for worker raises. If approved, 517 staffers would receive a $12,000 annual salary increase.
“Sometimes we do feel like we don’t get enough attention,” Wold said. “Not just from the Legislature, but from the media and from the community and so we do feel like we have to continually try to get our message out, make sure people are aware of who we are and what we do.”
Right now the program is “a gathering storm,” said Tim Morstad, associate state director for AARP Texas. He pointed out that the agency made a request for a $10.7 million budget increase during the 2017 session to add caseworkers. The House approved it, but the Senate did not.
“This has been an identified issue for a while and they need additional funding to keep up with Texas’ aging population and the fact that more Texans are experiencing abuse and exploitation,” Morstad said.
In a strategic plan published in March, APS raised the alarm about high turnover, and indicated that the program is “too small to adequately address the needs” of the growing older adult population. Agency leaders also cited a lack of adequate funding and a lack of legislative awareness as problems.
Anne Heiligenstein, the Texas Department of Family and Protective Services commissioner from 2008 to 2011, said it was tough balancing attention between the adult and child welfare agencies. Child Protective Services is a larger program than Adult Protective Services and when attention is on child abuse or deaths, “that does absorb much of your time as commissioner.”
She fought for caseworker raises but didn’t convince legislators like current Department of Family and Protective Services Commissioner Hank Whitman was later able to do. She said his law enforcement perspective gave legislators fresh eyes on caseworker challenges. But without more raises, “you will have a natural migration from APS to CPS.”
“He was the one that could go to the Legislature and say ‘I send 23- and 24-year-olds into homes I wouldn’t send officers into without backup,’” Heiligenstein said. “The danger factor may not be as high in APS cases but the homes that you’re going into, certainly the upsetting things that you have to see and do … the emotional toll that has to take on the caseworker in order to be able to do that.”
Wold said it’s hard to explain to people why adult clients stop bathing, eating, taking their medications or refuse help with their plumbing or housekeeping. Explaining child welfare is simpler.
“To be blunt, children are cute,” Wold said. “Everyone loves kids and everyone knows that children shouldn’t be abused. I think that’s a very easy thing to agree on.”
Part II will cover the history of changes in the agency and how the agency protects clients who aren’t being abused by others.
Disclosure: AARP Texas has been a financial supporter of the Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
This article was first published at https://www.texastribune.org/2018/10/09/texas-cps-aps-forgotten-caseworkers-legislators by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.