Miss Leslie is bored. She’s waiting outside a brick apartment building just south of Prospect Park for a city marshal to show up and evict a tenant. As a caseworker for the city agency Adult Protective Services (APS), her job is to assist adults who have trouble caring for themselves because of physical or mental disabilities.
On this cool October morning, Miss Leslie is fulfilling her final responsibility in the case of Mary Ann Stroud, a disabled 50-year-old who will lose her apartment because she fell behind on her rent. Leslie’s brief efforts to put the eviction on hold failed. As she explains it, she just got the case a few weeks ago, so there was little she could do. Now her only role is to be sure that Stroud has a safe place to go.
A neighbor walks up to Miss Leslie demanding to know what’s going on. When he finds out Stroud is in the process of being evicted, he’s pissed. “She can barely get down the steps!” he tells Miss Leslie. When the caseworker says that Stroud might not be able to keep her three dogs, his anger builds. “It’s bad enough she’s losing her apartment,” he says, shaking his head. “Now you want to take her dogs away too? She loves those dogs!”
Miss Leslie doesn’t show much sympathy for Stroud. It’s a tough city. There’s not much housing available on Stroud’s $604-a-month budget, and there’s nothing either she or APS can do about that. When Stroud had asked her a few days ago how she could find a new apartment after the eviction, “I told her, ‘Write your Congressman,'” Miss Leslie says, smoking menthol cigarettes as she calmly waits. “We’re not in the real estate business.”
Fifteen minutes later, the eviction is complete. The marshal arrives, the super opens up Stroud’s apartment. Finding neither her nor her dogs present, the marshal puts new locks on the door.
Just a few blocks away, at a park bench in the Parade Grounds, Stroud sits sleepily, the three mid-sized, mixed-breed dogs–Jada, Jasmine and Moët–calmly at her feet. She can sleep on a friend’s couch around the corner for a few weeks, and she has found a place for the dogs for at least a few days. After that? Who knows.
She was up all night packing stuff to move out, but Stroud coherently details the story of how she came to lose her apartment. It’s rather different than Miss Leslie’s version.
“My case was terribly mismanaged,” says Stroud, a bright but clearly pained woman whose spiral into homelessness began in December 2000, when she tripped on the sidewalk, stepped in a hole and broke her foot badly. She lost her $9-an-hour receptionist job at the Pacific College of Oriental Medicine, which had been just enough salary to pay for her $775 one-bedroom apartment. For several months, she was able to pay her rent with her savings and that modest disability check. But beginning in June 2001, she fell behind.
That September, her landlord began the lengthy eviction process. For the next year, despite debilitating back pain that arose after her foot injury, Stroud tenaciously sought help. Her hope was to get enough money from the government to pay her back rent, and then to find a decent job again. But in a series of bewildering bureaucratic moves, the city Human Resources Administration denied her rent application twice, for different reasons each time, even after she presented her case at an appeal hearing. Then, as her eviction date grew near, and a Housing Court judge determined that her injuries were sufficient to incapacitate her, she was ultimately directed to APS and Miss Leslie.
On September this 10, Miss Leslie visited Stroud at her apartment, and suggested various possibilities for averting the eviction. Maybe they could get part of the back rent from an outside charity, or try to convince the landlord’s attorneys to wait a few months, until Stroud’s health cleared up enough for her to get a job and start paying the rent back. Stroud was thrilled, optimistic for the first time in several months that there was a chance she might not lose her apartment. According to Stroud, Miss Leslie then promised to mail the charity application and a sample attorney letter so that they could begin the fight.
The paperwork never came. The next time Stroud saw Leslie was the day of her eviction.
They’re dangerous. Their staff is ill trained, and some workers even have criminal records. Their doors are locked and their clients are neglected–sometimes actively abused. That’s the assessment of institutions in New York that house the mentally ill and elderly, according to recent high-profile news reports. Such horror stories have reinforced what professionals had already concluded: The best place for adults who need some help, whether due to age or mental infirmity, is in the community, not an institution.
Studies show that both the elderly and mentally ill maintain their health and independence longer when they live in familiar environments. And even if a vulnerable adult gets an array of supportive services while at home, research shows that’s still less costly than the institutional alternatives.
“A lot more efforts are going on to maintain people with various kinds of cognitive impairments at home,” says Stephen Crystal, a Rutgers University professor who studies aging. “We’re continuing as a society to try and move away from the institutional model in long term care.”
Three years ago, the U.S. Supreme Court weighed in and agreed: A person with mild to moderate disabilities should remain living at home. If such a person doesn’t have family or friends to make sure he pays his rent, keeps his apartment moderately clean, eats properly and gets periodic medical attention, it’s up to the government to step in.
In New York, that’s explicitly the mission of Adult Protective Services, a division of the city’s Human Resources Administration, charged by state law with helping anyone over 18 who because of mental or physical impairments can no longer provide for his or her basic needs, and who has no family or friend willing to help. APS is the front line of a defense designed to allow some of society’s most vulnerable members to live safely in their own homes–not in institutions.
It’s a broad mission, one that translates into everything from paying the bills for a slightly absentminded old person to hiring a cleaning company to throw away years of accumulated junk in a still-occupied apartment. APS is not the only authority with responsibility for the elderly and mentally ill–guardians appointed by state judges also play a role [see “On Guardian,below]–but it is the first call for a neighbor who’s disturbed by the growing smell from next door. Or, as in Stroud’s case, from a Housing Court judge concerned that an eviction will throw a disabled adult into the street.
Those calls are answered. But far too often, according to professionals who work with the elderly and mentally ill, APS caseworkers make mistakes and misjudgments, and the clients they’re supposed to be helping remain mired in crisis.
Take the case of Mr. B, a 65-year-old mentally retarded man who lived in a tiny room at a Queens SRO hotel on a small amount of money he earned from part-time work. In early 2001, Mr. B’s landlord tried to have him evicted because his room was cluttered with junk. Mr. B’s attorney, Kim Breger of Legal Services for the Elderly (who declined to share her client’s full name) was able to convince the landlord to let Mr. B stay, as long as his room was professionally cleaned from time to time. Breger turned to APS, which had been helping Mr. B manage his finances for several years, and asked them to get her client on Medicaid home care, which would pay for the housekeeping.
More than a year passed. APS never applied for home care for Mr. B, despite repeated entreaties from both Breger and the Housing Court judge. The room never got cleaned–and still hasn’t been to this day. Mr. B ended up losing his room a few months ago, not due to an eviction, but when he entered the hospital.
Those simple failures–to fill out the proper form; to make the right phone call–regularly mar APS’ work, say professionals who work with elderly and mentally ill New Yorkers. “Cases just get forgotten about for months,” says Ed Josephson, director of the housing law unit at South Brooklyn Legal Services.
APS’ problem-solving reputation is so bad that many social workers and attorneys say they have learned to contact the agency only in the direst situations, out of the fear that as caseworkers solve small problems they may create bigger ones. Lawyers tell stories of clients for whom APS sought to appoint permanent legal guardians with absolute decision-making power, even when they themselves felt confident the client only needed their house cleaned and their bills paid. “We don’t want to let a government agency off the hook,” says Denise Tomasini, an attorney with the Goddard-Riverside Tenant Assistance Project. “But it’s just not good for our clients. We avoid them like the plague.”
The case of Mary Ann Stroud is hardly the worst horror story of what happens when APS fails. Miss Leslie’s lack of followup may have helped her lose her apartment, but Stroud is fortunate to have some friends who can put her up at least temporarily, and enough skills to land her a job once her health clears up.
But take a close look at how little Miss Leslie actually did, other than make sure that Mary Ann Stroud didn’t get thrown out onto the street–or shot by a marshal. The roots of the work that APS does today–and doesn’t do–can be traced back to 1984, when cops killed Eleanor Bumpurs, a severely mentally ill 66-year-old woman who was shot after violently resisting her eviction from a housing project. She owed just $417.10 in back rent.
The case generated massive publicity, and since then making sure that evictions don’t lead to tragedy has been one of APS’ principal mandates. In fact, a full 60 percent of its current caseload begins with the threat of an eviction. It’s critical work. If your mission is caring for the old and sick, and institutions are an unpalatable alternative, then fighting to keep vulnerable adults in their homes is necessarily a priority. Especially in a city with historic housing shortages and landlords always eager to bring in higher paying tenants.
Would-be Eleanor Bumpurses are threatened with eviction every single day. At a minimum, APS is there when the city marshal arrives, to make sure a bad situation doesn’t become worse. But at some point, does preventing tragedy amount to allowing evictions to happen?
In most of the evictions that Tina Brooks of the Urban Justice Center has witnessed, she says the caseworkers are chiefly focused on ensuring that the eviction happens without interruption: “They seem to be there to make sure the tenant doesn’t obstruct the marshal.”
Deciding whether to keep an older or mentally ill person in the community calls for decisions that are rarely clear-cut. Just because a mentally ill woman stinks because she rarely bathes, does that mean she can’t take care of herself? When an old woman has six dogs that piss and shit on newspapers that don’t get changed, is that a sign of incompetence? Does an ailing elderly man who has only eaten potato chips and butter for the last two years need a guardian? Is wearing shorts outside all winter a sign of dementia?
Such trying ethical and social work dilemmas define the work of the APS staff. Even if they do a terrific job, their work is always underappreciated. Most of their clients don’t want help. Clients’ neighbors or associates are rarely pleased with the outcome, either unhappy that the person wasn’t evicted or the apartment remains dirty, or angry that their friend was moved to an institution.
The agency does have its success stories. In June, Robert Williams, a 50-year-old man with mild mental retardation, found an eviction notice tacked to the door of his room at a Central Harlem SRO hotel, where his rent is $240 a month. His landlord wanted to evict him for owing a few months rent that Williams had missed paying while visiting relatives in the South.
When he went before a Housing Court judge in July, he feared he might lose the tiny, cluttered room, equipped with cable TV, a phone and plenty of canned food, that he has called home for a decade. But the judge quickly reassured his fears, put the eviction on hold, and directed him to an APS caseworker so that he could try and get his back rent.
It worked. The city approved a grant to pay his back rent, and APS put Williams on a financial management plan so that he doesn’t fall behind again. That’s good, Williams says, since not being able to read or write makes paying bills difficult. Now, he says, “I’m up to date. Everything seems to be working out perfect.”
Such experiences show how much APS can and does matter. Only this agency has the legal power to pay bills for an easily confused client, or to make sure she doesn’t face eviction while simultaneously having thousands in the bank or under the mattress. Its caseworkers can convince colleagues at the city’s social services agency to approve one-time grants for back rent to avoid evictions. They can bring a psychiatrist to a tenant’s home to determine the extent of a mental disability, or order a cleaning team to make an apartment safe.
The need for its services is only increasing. Not only is there new momentum to keep mentally ill people living in the community, but the sheer number of very old people in New York City is growing. There are 1.3 million people age 60 and over. The number older than 85 grew by 18.7 percent between 1990 and 2000.
On February 5, a city marshal evicted 79-year-old Mattie Thompson and her sister Mary from the Morningside Heights apartment where Mattie had lived for nearly half a century (Mary arrived in 1968). The next day, their landlord immediately rented out their rent-controlled apartment to a new tenant, raising the rent from $246 to $800.
The sisters were forced into a nearby nursing home. With limited incomes–about $1,600 in Social Security each month between the two of them–and Mattie’s diabetes and recent bout with breast cancer, looking for a new apartment was unthinkable. “Age is starting to get to me,” Mattie, a retired nurse’s aide, told her HRA psychiatrist.
Keeping the Thompsons in their apartment should have been as simple as applying for $13,000 in emergency back rent from the city. (According to APS, about 80 percent of the applications for back rent it makes are approved.) The Thompsons’ application was ultimately okayed–but not until four months after they were evicted, once a Housing Court judge discovered that the Thompsons’ APS caseworker and their court-appointed guardian both failed to ask for the correct amount of back rent.
The Thompsons’ case, unlike so many others, ended well. Judge Michelle Schreiber ordered the sisters returned to their apartment following what she called an “utter failure” on the part of both the agency and the court-appointed guardian. It was not a decision made lightly–Judge Schreiber had to evict the 37-year-old woman who had subsequently moved into the apartment.
APS agrees with the judge’s decision. An agency spokesperson said “errors were made,” and pledged to “make every effort to see that this never happens again.”
Errors similar to those that nearly left the Thompsons marooned in a nursing home plague every step of the process that’s supposed to keep vulnerable adults in their homes, attorneys and advocates for the elderly say.
Referrals to APS–typically from a neighbor, landlord or Housing Court judge–are first screened by phone. Most are initially accepted, then forwarded to the agency’s more rigorous assessment unit, which has 60 days to decide if the agency will offer its services.
Once a case is accepted, APS provides resources that range from house cleaning to financial management. For the bulk of its cases, the first step is to try and apply for emergency housing funds from HRA’s rental assistance unit, which aids not just APS clients but welfare recipients and other needy New Yorkers, too. (Last year, APS received $1.1 million in back rent funding for 418 clients.) The grants for back rent are one-shot deals, however, and HRA will only approve an application if a client currently earns enough money to guarantee his or her ability to pay future rent. Mary Ann Stroud, for one, failed that test.
APS caseworker Miss Leslie says that these resources are difficult to procure for clients. When she asks for benefits from other HRA departments, like those that award Medicaid or food stamps or cash assistance, she is often thwarted. “We’re all in the same agency,” Miss Leslie said that morning, before Stroud’s eviction, “but to get anything done you have to…” and she waves her index finger in the air around and around.
While APS isn’t unique for having bureaucratic snafus and delays, consider the state of its clientele. Most have some blend of mental illness, dementia, paranoia and physical disabilities. “It’s impossible for an attorney to navigate APS,” says Tomasini, “I can’t even imagine being mentally ill.”
At the heart of the pattern of small but critical mistakes that permeate APS’ work are the agency’s 220 caseworkers, critics say. There’s no question that APS casework is difficult: Entering an apartment where someone of questionable mental stability lives requires courage. Having the fortitude to investigate the cause of an overwhelming odor of feces demands an unusually steady will. Gently quizzing a suspicious and likely hostile client calls for strong communication skills. But given all that, APS caseworkers far too often lack the basic skills and commitment required to do even an adequate job.
Critics point to APS’ hiring process as a major problem. Prospective caseworkers need a bachelor’s degree and have to pass a general civil service exam for entry-level caseworkers. Those who pass can apply for any open caseworker slots, in agencies from Department for the Aging to the Administration for Children’s Services. Since APS work has a well-earned reputation for being literally the dirtiest and most thankless, observers say, it’s generally the least qualified caseworkers–the ones who can’t get hired at other agencies–who apply to APS. “It’s like they say in El Paso about the Red River,” offers Ken Onaitis, the director of the crime victims assistance program at the Burden Center for the Aging on the Upper East Side. “By the time the river runs down here, it’s pretty dry.”
Agency perks lag behind those of their colleagues at agencies like ACS, which entices new employees through prospects of career advancement: The children’s agency added a program in 1999 that helps new caseworkers earn a master’s in social work after hours.
Hiring and retaining staff has been so difficult for APS that only recently–and briefly–was the agency able to meet its state-mandated goals for caseload ratios, which are 15-to-1 for its eviction and assessment units and 25-to-1 for its ongoing care unit. As recently as June 2001, when the City Council held a hearing on protective services, the caseworker’s union chief, Charles Ensley, testified that ratios regularly went above 40-to-1.
Despite their grievances with the city services assigned to keep vulnerable adults in their apartments, the professionals who work with the elderly and mentally ill say they want more of them. They may throw up their hands at the months it takes to file a piece of paperwork, or the caseworker who misses repeated appointments, but social workers and attorneys say that, ultimately, their clients need APS to be not just better but bigger.
That’s because right now, APS refuses to assist most people who seek its services. Last year, the agency rejected 5,823 of the 7,919 cases it assessed. APS Deputy Commissioner Linn Saberski, who reports directly to HRA Commissioner Verna Eggleston, says they’re just following the law. For each of those denials, APS determined either that the client was in good enough mental and physical shape to take care of herself, or they discovered someone else, like a friend or relative, who could take care of her instead.
Not true, say the agency’s critics, who say that adults who clearly need outside help to stay in their homes are consistently refused. Most commonly, they say, APS automatically rejects anyone who has an attorney or caring neighbor or even a distant relative, even when that support is clearly inadequate.
For example, Tomasini remembers an elderly man whom APS refused to help because his ex-wife–who lived in another state, and had no intention of helping him–had called them to alert them of his impending eviction. The agency told Tomasini that her call constituted evidence that he had family who could step in.
APS also refuses cases if it thinks another city agency might take on the work. Ed Josephson tells the story of a 37-year-old woman with two small children and a mental disability whom his office fought to keep in her house when she was threatened with eviction. APS first turned her down because a caseworker said it was an Administration for Children’s Services case. Then the agency said that since she had an attorney, she didn’t need help from APS. Ultimately, a judge agreed with Josephson and ordered APS to take the case.
Critics of APS assume that the agency refuses so many cases because their resources are limited: With just 220 caseworkers, the thinking goes, APS decides to accept only the direst cases. But the agency’s chief denies this. “Our decisions aren’t based on resources,” says Saberski, stressing that the only factors are the severity of the potential client’s disability and the presence of other caregivers.
Yet city data itself suggests that resources may in fact be an issue. Even as the number of referrals has risen sharply over the last four years, from 6,662 to 10,105, the agency has maintained a caseload that’s remarkably similar, always between 3,753 and 4,000. (APS asserts that the number of referrals has spiked because it has redefined what a referral is.)
The numbers that can’t be argued with are the dollars and cents: the agency’s resources have barely increased, from $21 million in 1996 to just $23.9 million this year, according to the Independent Budget Office.
For years, APS seemed impervious to outside criticism. Typical of its attitude was the response of former Deputy Commissioner Sandra Glaves-Morgan in 1996, when a New York Times reporter asked whether she thought her casework staff suffered because few had specialized training in working with the elderly or the mentally ill. “We prefer it that way,” Glaves-Morgan said. “You really don’t want someone who’s a stuffed shirt, ‘Hi, I’m an M.S.W., la di da.'”
These days, APS’ new leadership seems to be taking client dissatisfaction more seriously. Its current leadership, personified by Saberski, has brought positive energy and a listening ear to the agency, critics say. “There’s some very capable people leading APS,” says Janet Lessum, an attorney at Bet Tzedek Legal Services who has more than a decade of experience working with the agency.
In her four years, Saberski has instituted a series of reforms, the most promising of which is a restructuring of staff territory. Previously, a caseworker had cases throughout a borough–she might have to visit clients in both Astoria and Ozone Park in the same day. But in a shift that’s already in place for certain units in Manhattan and will extend to the whole city by next year, caseworkers and their supervisor are now assigned to geographic districts. Not only will that cut down on travel and allow caseworkers more time, says Saberski, but it will allow APS staff to develop consistent relationships with neighborhood institutions that already serve the elderly. “We hope it will lead to more joint work on our clients’ cases,” she says.
Neighborhood groups in Manhattan say they welcome the change–in fact, they lobbied for it for years. Local help is essential, says Rebecca Carel, executive director of Ft. Washington Houses Services for Elderly in Washington Heights. “We have a wealth of knowledge. We know where the grandson lives. We know their favorite food is yogurt. If the APS caseworker goes in with our worker, the elderly person is much more likely to be receptive.”
Other Manhattan providers of aid to the elderly remain skeptical that the caseworkers they’ve had such a difficult time with will suddenly be responsive to their suggestions for how to handle a case. “They’ve supposedly started a program,” says Onaitis. “But their workers have never called me. And as far as I know, none have ever called any of our partner agencies either.”
Crisis services for adults have been so weak that advocates for the disabled have turned in desperation to a class action lawsuit. In April, the New York Legal Assistance Group sued the city of New York for systematically refusing clients without legal justification. Its complaint also attacked the agency’s failure to adequately provide services to the clients it does accept.
NYLAG filed this suit in hopes that they could provoke similar changes to those that helped reinvigorate the city’s child welfare agency. “As a result of litigation, they’re paying higher salaries to their caseworkers,” observes NYLAG attorney Jane Stevens. “It’s a good example of how litigation and advocacy can squeeze the balloon.”
As City Limits went to press, NYLAG was in the midst of serious talks with APS that Stevens hoped will soon lead to a settlement. APS is offering to rework its assessment process to more carefully examine a prospective client’s other options before ruling him or her ineligible. In addition, APS is promising better coordination with the city’s Department of Homeless Services, so APS clients who are evicted can have more direct access to housing subsidies and programs.
The prospect of resolution forces one immediate question: How could APS possibly handle additional work? There’s one word that everyone, including Miss Leslie, uses to describe the agency’s 220 caseworkers: overwhelmed. Without additional resources, additional casework seems like the last thing APS can do right now. NYLAG recognizes this danger: “Unless there’s a new infusion of money,” says Stevens, “it wouldn’t be very easy to accomplish new things.”
Success doesn’t have to be unthinkable at APS–if the agency secures the resources to step in and do what’s necessary to keep a vulnerable adult in the community. In the current New York budget crisis, any additional money will have to be fought for aggressively.
Robert Williams, for one, is grateful that someone figured out how to save his modest room, so that he can stay in his neighborhood and continue to volunteer at the local soup kitchen. And continue to go to the same shops where he knows where the bargains are and the cashiers won’t take advantage of him. “I’m a good tenant,” he says. Thanks to what he calls “those nice ladies”–his Housing Court judge and caseworker–“No one can mess with me,” Williams says proudly. “I can stay in my home.”
SIDEBAR: On Guardian
Adult Protective Services can’t do the job of keeping an elderly or mentally ill person in her apartment on its own. More often than not, that battle is played out in Housing Court, where trained legal representation is essential. Judges will typically appoint an attorney–known as a guardian ad litem, or law guardian–to act as a legal advocate for a defendant threatened with eviction.
On the face of it, the law guardians seem like an effective means for keeping indigent vulnerable adults in the community. But Housing Court observers say their efforts are limited, and even counterproductive. The problem more than anything is one of compensation: the court doesn’t pay law guardians enough to attract lawyers with skills and commitment. They earn about $400 per client, no matter how much work a case demands.
So guardians have a well-earned reputation for minimalist work. They will cursorily apply for benefits, but won’t appeal when denied. They won’t go out of their way to make a case seem compelling in order to convince jaded judges and HRA caseworkers. Law guardians are also prone to quickly sign agreements to pay the rent–to delay the eviction under the hopes the money will eventually come through–without first making sure that a landlord’s claims are legitimate.
“While the guardian idea is well-meaning, they tend not to do a lot of follow-up,” says Toby Golick, director of Cardozo Law School’s Bet Tzedek Legal Services, which provides advice and representation to the elderly. Adds Josephson, “They’re not the type of people who make strenuous efforts on behalf of their clients.”
One such guardian, Queens attorney Ralph Pennington, defended his role in the Thompson sisters case (which the judge called an “utter failure”) by saying that he had done everything he could–it was the APS caseworker he was working with who failed. “They don’t act promptly,” he says. “They’re overwhelmed.”–MP