The Long, Long Road of COVID

Robert Earl Keen, a Texas singer-songwriter, wrote and performs a song called “The Road Goes on Forever (and the Party Never Ends)” – sometimes derisively referred to as the “the Song That Never Ends”, like this sentence and the pandemic – about a Bonnie and Clyde type couple (Sonny and Sherry) who have a few adventures in crime, ending up with Sonny “going to the chair” while “Sherry pulls onto Main Street in her new Mercedes Benz.” I use that song as a reference point because I suspect that is how many of us feel about COVID at this point: a seemingly never-ending road with horrible detours but, hopefully, a destination that results in APS program improvement.

The APS TARC has been tracking and analyzing the impact of COVID throughout the pandemic and creating resources to support the field. The activities to date have included:

• Collecting information on policy and practices changes at the start of the pandemic.
• Hosting a webinar on the pandemic-driven, quick transition to mobile work and posting a companion blog post with six brief podcasts on how to manage a mobile workforce successfully.
• Creating a toolkit to help investigators.
• Conducting a qualitative analysis and analyzing NAMRS data to assess the impact of the first wave of the pandemic.
• Facilitating monthly Peer-To-Peer calls with workers, supervisors and administrators where the impacts of COVID on all aspects of APS program and practice was a hot topic of discussion.
• Including analysis of the impact of COVID based on NAMRS data in the 2020 Adult Maltreatment Report.
• Holding discussions with front-line staff about the long-term impact at workshops at the Texas APS and National Adult Protective Services Association (NAPSA) conferences this fall. 

We wish the COVID-19 road trip was complete, but since it is not, here are a few reflections to consider as we journey forward. 

1. APS was mostly not prepared for the disruption but has learned a lot. APS was hardly alone in not being prepared. APS programs had to make many adjustments on the fly – adjustments they had not planned for and often did not have the infrastructure to support. This caused immediate stress but also resulted in staff that ultimately were better equipped with technology and enhanced work flexibility through remote work. It appears remote work will become the norm for many programs and, hopefully, we have learned a lot to better plan for emergencies like pandemics.

2. APS was treated like “first responders” when it came to the work in responding to COVID even though APS often did not qualify for the resources available to “first responders.” Remember the burning question back in May of 2020: who has personal protective equipment (PPE) and how can my program get it? Time and time again, APS staff were called upon to do vital front-line work in the community, often outside the scope of their regular jobs, without the protective resources that other “first responders” had. Anecdotally, one positive result of COVID is that there seems to be a better understanding in local communities and state agencies about the role of APS, even going so far in some communities to now officially designating them as “first responders.” 

3. APS workload was impacted, although we do not know yet what the long-term impact will be. The last chapter of the NAMRS 2020 Adult Maltreatment Report looked at the impact of the first wave of COVID (April – June 2020) on APS programs as it could be measured in NAMRS data and found that:

   1. The number of reports to APS remained about the same in FFY 2020 as FFY 2019 and reports accepted decreased slightly.
   2. For FFY 2020 overall, the total number of investigations decreased slightly. The number of investigations decreased in the early stage of the pandemic. Of particular note was a decrease in the percentage of reports from professionals.
   3. While there are some changes in the data for case closure reason and durations, it is hard to separate the changes in the data during the pandemic from the longer term trends and individual state changes.
   4. The percentage of self-neglect cases increased during the early months of the pandemic.
   5. There was also a short-term increase in substantiation rates during the early months of the pandemic, potentially associated with the increased percentage of self-neglect cases.
   6. There was no change in the demographic characteristics of APS clients during the early months of the pandemic.

Because of the timeframe of the 2020 NAMRS submission, this was only a snapshot of the first few months of the pandemic. We will take a longer term look at the impact COVID had on APS in next year’s report. 

4. APS policy and practice changed, hopefully for the better. Remember that critical conundrum in the early days of the pandemic: how do you meet face-to-face requirements when you can’t do face-to-face visits? We learned that face-to-face visits are one of the practices that positively distinguishes APS from other social service providers. APS programs figured out creative solutions to this question, some of which will result in positive change in policy and improvements in practice. For example, caseworkers had to get creative in the way they interact with clients to do a comprehensive assessment, such as taking pictures, use of technology for communication, and making better interaction/use of collateral contacts. Some states have indicated they are permanently changing face-to-face requirements based on what they have learned about what does work and does not work.

5. APS cases became more complex and unfortunately the quality of investigations suffered in some cases. As social isolation increased and other community providers were often limited in their ability to meet needs or unable to provide services, APS ended up with referrals that previously would not have been so severe. Not only were the situations more severe, but the ability to address them was limited by pandemic restrictions on access to clients and collaterals and availability of community partners. For example, NAMRS data showed a dip in referrals from health professionals, presumably caused by the lockdown, resulting in APS clients whose condition continued to get worse before a referral was made to APS post lockdown.  

6. APS’ unique role as vital community partners was recognized, which may have long-term benefits. My notes from feedback from the Texas APS conference workshop put it bluntly: “Lots of people not doing their jobs: hospital discharge planner, various [other] program staff, mental health. Many are still not doing F2F [face-to-face].” In many communities, APS is picking up these pieces. Staff in the conference workshops indicated there is greater recognition in their communities about the importance of APS. Maybe an Aretha Franklin song – R.E.S.P.E.C.T. – will become our new theme song.

7. APS staff are heroes, and they are now more widely recognized for the heroic work they do. While recognition matters, certainly, more resources are a better reward. The new federal funding recognizes the importance of APS and is crucial to continued program improvement, but we all need to work together to reward those that deserve it most:  APS investigators and supervisors. Again, anecdotally, based on discussions, the new recognition of the vital work of APS staff is resulting in increased pay and improved work conditions for some APS staff, while others are better able to make the case for it in their communities and agencies. 

As the Omicron variant rages, the COVID road seems like it is going to last forever, but the epidemiologists tell us that the party will at least become “endemic” someday, even if they can’t say when. While APS may never be the Mercedes Benz of social service programs, if we all continue to work together, COVID is providing us with the opportunities to upgrade the model we are currently driving.

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