text:
TeamSpeak 3
TeamSpeak 3 SDK
TeamSpeak 2
TeamSpeak Classic
System Requirements
Market Share
Global Partners
About Us
Calendar of Events
Latest News
Jobs & Careers
Legal Notices
Contact Us
FAQ / Knowledgebase
Video Tutorials
Getting Started
Premium Support
Customer Center
Rent a Server
Licensing Overview
Help Choose License
Non Profit License
TeamSpeak 3
TeamSpeak 2
Media Kit
Search Forums
Here's the latest news about what is going on at and around TeamSpeak.
Page 14 of 15
TeamSpeak Anti-Piracy Initiative Update
by Florence Espinoza on Jul 17, 2005
The TeamSpeak Team would like to thank you all for your overwhelming response to our anti-piracy initiative. We are pleased to announce that as a result of your ongoing efforts to help us identify illegal TeamSpeak hosters we have compiled a list of known illegal TeamSpeak hosters that will be posted for public viewing via our Hosters & Renting page. With the release of this list, it is our goal to increase consumer awareness to ultimately eliminate any possibility of TeamSpeak piracy, giving our legally licensed customers the business and recognition that they deserve.
This list will obviously be an ongoing work in progress, so we encourage you all to continue notifying us of any witnessed illegal activity via our piracy email address
Please keep in mind that due to the volume of emails received our piracy team generally will not respond to your emails unless additional information is required. With that said, be assured that every email we receive will be properly investigated and that appropriate action will be taken.
In addition to the list, each Authorized TeamSpeak Host Provider (ATHP) can now link directly to a unique, static page on the Hosters & Renting area. Simply search for your company name on the Hosters & Renting page, click on your company in the search results, and the web address will reflect your company's unique URL that you can link to from your site to show your customers that your company is in fact an ATHP.
Again, we thank you all for your hard work as your contributions and dedication have helped make this project possible.
TeamSpeak Anti-Piracy Initiative
by Florence Espinoza on May 4, 2005
The TeamSpeak Team has begun a new anti-piracy initiative to warn, try to work with, and in the worst case scenario ban illegal hosters and TeamSpeak servers. If you are hosting TeamSpeak illegally, and you do not try to make contact with our sales department via
, we will eventually track you and ban your servers.
Unfortunately this issue has existed for a long time and we promise to all paying and licensed customers that we will continue to work hard and eventually track and stop all illegal hosters. Thank you for your attention to this matter. If you have any specific questions please address them to
Got questions about licensing in general? Are you part of a clan or guild and not sure if you need to pay? Please be sure to read through our FAQ before you send us your inquiry via email. If you still have questions we will be more than happy to assist you.
Collector's Edition of Guild Wars® features TeamSpeak
by Florence Espinoza on Apr 26, 2005
A special Colletor's Edition of Guild Wars® will be available on the game's release date. This bundle will feature a 3 month TeamSpeak server hosted by Speakeasy/Game Daemons. Among other goodies, the bundle will also include a Logitech headset. The service itself will consist of an 8 slot server free of charge to the customer for 3 months. After the 3 month period expires customers will have the option of continuing service if they so choose.
Please visit the
official Guild Wars® website
for more information.
Speakeasy/Game Daemons launches TeamSpeak Initiative
by Florence Espinoza on Mar 18, 2005
TeamSpeak Systems and Triton CI & Associates, LLC are proud to announce Speakeasy/Game Daemons as our newest official partner.
TeamSpeak will now be featured in Speakeasy's GameCloud™ gaming initiative. GameCloud™ is an international infrastructure of servers, content repositories, online services and editorial properties that operate on multiple internet backbones and dozens of peering connections in order to deliver the best on-line gaming experience possible.
In addition Speakeasy is releasing TeamSpeak as a value-add to their broadband gaming packages. This will introduce TeamSpeak hosting by Game Daemons to all of their existing and new broadband subscribers. With an unparalleled infrastructure through its GDX platform and the Speakeasy network, Game Daemons is able to provide one of the largest geographic VoIP solutions in North America and Europe.
For more information on Game Daemons' TeamSpeak hosting services please visit
Happy Holidays
by Florence Espinoza on Dec 23, 2004
Wishing you all happy holidays and best wishes for the new year from everyone here at TeamSpeak.
Thank you.
ATTENTION TeamSpeak Users
by Florence Espinoza on Sep 1, 2004
In early June 2004, many users within the TeamSpeak community informed us of a possible virus issue - specifically with the
file which is installed by the TeamSpeak 2 client.
Since we were informed of this issue the TeamSpeak Team has been heavily involved in trying to determine the accuracy of this claim. After rigorous internal testing and numerous phone calls into all of the major antivirus companies including Symantec (Norton AntiVirus), Network Associates (McAfee VirusScan) and Trend Micro, NONE of these companies can verify NOR deny that a virus actually exists in
The Problem:
To the best of our collective knowledge, it is so far more likely that this is a false positive - meaning that the antivirus application is finding data in keypress.dll that LOOKS like the same sort of data found in an infected file containing the Trojan "PWS-Wexd" (virus)... even though the file is most likely not infected at all.
If you are still truly concerned that this may actually be a virus, please try visiting the following link:
This URL contains detailed information on the PWS-Wexd Trojan, including a section on indications of infection - which we have meticulously verified so far do NOT exist on anyone's supposed infected computer.
The Solution:
At this time we have put together a new TeamSpeak client installation executable.
Simply shutdown your TeamSpeak 2 client if it is running and re-install TeamSpeak using the new executable right on top of your existing installation and the problem should go away. It is NOT necessary to first uninstall your existing TeamSpeak client and you will also NOT lose your current address book and other client settings.
It is our every intent to resolve matters such as these in a timely manner... and with as much information to validate a working solution as possible. We want to thank you for your patience as we work through this issue.
Please visit the following forum thread for further information and discussion:
Page 14 of 15
TeamSpeak 3
TeamSpeak 3 SDK
TeamSpeak 2
TeamSpeak Classic
System Requirements
Market Share
Global Partners
About Us
Calendar of Events
Latest News
Jobs & Careers
Legal Notices
Contact Us
FAQ / Knowledgebase
Video Tutorials
Getting Started
Premium Support
Customer Center
Rent a Server
Licensing Overview
Help Choose License
Non Profit License
TeamSpeak 3
TeamSpeak 2
Media Kit
Copyright © 2014 TeamSpeak Systems GmbH. All rights reserved.
All trademarks referenced herein are the properties of their respective owners.


text:
What is the role of the Local Workforce Investment Board (LWIB)?
Each of New York State's 33 workforce investment areas has a LWIB that is empowered to set policy concerning the workforce development system in their local area. The LWIB's duties include development of the local workforce development plan, selection of One-Stop Center operators, selection of service providers to youth, identification of the eligible providers of training services, development of budgets, program oversight, negotiation of performance measures, and establishing linkages between the system, economic development strategies and employers in the area. LWIB membership comprises representatives of: the business community (who form the majority of the board), local educational entities, labor organizations, community-based organizations, economic development agencies, and each of the One-Stop partners.
More Info
Local Workforce Investment Boards in New York State
Information on membership of each of the State's 33 Local Workforce Investment Boards, their Chairs, the local workforce investment areas of New York State, and local contact information.
URL: http://www.workforcenewyork.org/localarea.html

subset: commoncrawl


text:
Patton, Pending
The sexy star of Mission: Impossible—Ghost Protocol strips down and dishes on what it's like to be Alan Thicke's daughter-in-law
January 2012
1 of 4
Swimsuit by Keiko. Ankle boots by Tom Ford. Bracelet and ring by Maison Martin Margiela.
- Tags
- Women,
- Paula Patton,
- Movies + TV,
- What to Wear Today: 10.31.14
- New Designer Jogger Pants for Fall
- Your Daily Eye Queue: Bennett and Gaga for H&M, Shogun Style, and More...
- Instajack: Hailey Clauson (The Second Coming of Bardot)
- The Lazy Man's Guide to a Killer Halloween Costume: Day 4
- Sneaker of The Week: Nike Air Force 1 Mid "Flax"
News + Politics
- GQ Style: Wes Anderson's Highly Influential, Slightly Tweaked Take on Reality
- Jerry Lee Lewis Will Not go to Hell
- Matthew McConaughey: America's Space Cowboy
- Logan Lerman Went to Bootcamp with Brad Pitt for Fury
- Under the Influence: How Def Jam's Early Days Inspired this Season's Look
- Outlaw, Artist, Wild Man, Style Icon: How Dennis Hopper Inspired this Season's Look
How To
Food + Travel
- David Chang's Kitchen: Don't Get All "Fresh" with Me
- David Chang's Kitchen: Your Idea of Bologna is Total Baloney
- Chart: The Family Tree of Bourbon Whiskey
- Recipe: Semi-Summer Salad - Chef Jeff Taibe of Oak + Almond
- The Great Franco-Italian Pasta Experiment
- How to Pick from an Overpriced Restaurant Wine List


text:
Its maple syrup season for UM-Dearborns Natural Areas, and the Environmental Interpretive Center is hosting several related activities in the campuss sugar bush
February 11, 2010
DEARBORN / Feb. 11, 2010---Its maple syrup season for the University of Michigan-Dearborns Natural Areas, and the Environmental Interpretive Center is hosting several related activities in the campuss sugar bush.
The Center will offer a free Tree Tappin Time event from 1 p.m. to 3 p.m. on Saturday, Feb. 13. Participants will learn how to identify Sugar Maple trees by their bark, branches and buds, and then tap the trees. Children should be at least seven years old to tap trees.
Attendees should dress for the weather and potentially muddy and slippery conditions.
Then on Saturday, March 6, the Center will host a Makin Maple Syrup public tour from 12:30 p.m. to 2 p.m. Those that register for the tour by calling 313-583-6371 will enjoy an outdoor stroll with a naturalist to explore the process of making maple syrup.
Once the sap begins to run from the trees, individuals and organized groups will be needed to collect sap every day during the three or so weeks it flows, usually between Feb. 27 and March 27. Participants meet at 4 p.m. at the EIC and are in the field collecting sap for about two hours. Group size is limited to 25 people, including adults. Participants must be at least 7 years old for this activity. To register, contact Rick Simek at 313-583-6371.
About University of Michigan-Dearborn
The University of Michigan-Dearborn is celebrating its 50th anniversary throughout the 2009/2010 academic year. Founded in 1959 with a gift of just over 200 acres of land and $6.5 million from the Ford Motor Company, UM-Dearborn has been distinguished by its commitment to providing excellent educational opportunities responsive to the needs of southeastern Michigan. The university has 8,700 students pursuing undergraduate, masters, doctoral and professional degrees in the liberal arts and sciences, engineering, business, education, and public administration. With a faculty devoted to teaching, and students committed to achievement, UM-Dearborn has been shaped by its history of interaction with business, government and industry in southeastern Michigan, and is committed to responding to the needs of the region in the future.
CONTACT: Jennifer Thelen
The Office of University Relations
Room 1040, Administration Building
University of Michigan-Dearborn


text:
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text:
Prep Signing: Salisbury's Adams is a Western Michigan Bronco
SALISBURY — They say good things come to those who wait.
A patient Keion Adams waited and local sports fan Brian Messisco, an unofficial, let's say, mentor to prep athletes around here, came through.
Messisco knew Bill Kenney when he was an assistant at Penn State. When Messisco was told Adams hadn't signed, he made a phone call to Kenney, now an assistant at Western Michigan.
"The next thing I know," chuckled Salisbury coach Joe Pinyan, "I'm on the phone with Bill Kenney. He told me, 'We've got one scholarship and we need a defensive player. We like your guy.'
"And the next thing you know, Keion is flying to Kalamazoo, Michigan."
Just like that, Adams became a Western Michigan Bronco.
And he can't wait to play in the Mid-American Conference under head coach P.J. Fleck, a former Rutgers assistant who followed Greg Schiano to the Tampa Bay Buccaneers last season.
"He is fast-paced and a fast tempo," Adams said. "He took a lot of tools from the NFL and put them in a college program."
Adams was thinking of joining teammate Justin Ruffin as a preferred walk-on at Appalachian State but added, "This is a full ride. I couldn't pass this up."
Adams might get quality playing time right away, due to injuries and a need for linebackers. He said he could play a hybrid — half linebacker, half defensive end.
"I'll get to rush the passer and be a little DB," he said.
He'll also get to see a completely different atmopshere from Salisbury. Kalamazoo, a city of around 75,000, is a 12-hour drive.
"I'll get adjusted," Adams assured. "I wanted to get away and get into a whole different environment. See the world, basically."
Adams will definitely be seeing big-time football. Western Michigan opens at Michigan State on Friday, Aug. 30. The Broncos also play at Big Ten Northwestern and Iowa.
"He'll get to play on a big-time level and he's got to be excited about that," Pinyan said.
Simply put, Adams, at 6-foot-3, 230 pounds, was the best athlete on the football field in Rowan County last season.
Pinyan remembers the time he caught a pass against South Rowan and hurdled a player.
There was the acrobatic, one-handed interception against West Rowan. His biggest stop may have come on fourth-and-inches against High Point Andrews in a 36-35 win. Pinyan even goes back to Adams' sophomore year when he made two big catches to help Salisbury win a state championship.
"He's had a ton of 'wow' moments," Pinyan said.
And Adams has produced them in football, basketball and track.
"Imagine getting him on a program where they're feeding him and working him and having him focusing on just one sport," Pinyan said.
When the season began, ACC schools saw the athleticism and inquired.
"I don't know what happened," Adams said.
Doesn't matter now. Adams is glad he waited for the perfect opportunity. He said Western Michigan's campus was bigger than he expected and the football facilities are first-rate.
"It's a business, as far as recruiting," Adams shrugged. "I found the right business as far as Western Michigan."
Pinyan said he had only one request for the Bronco coaching staff.
"They need to get some nonconference games closer to Salisbury," he laughed.
Word is, Pinyan's got Brian Messisco on it.


text:
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The model for Speak Up Be Safe is based on several areas of research including child development, learning styles, social psychology, and child abuse and neglect prevention. It is written to promote broad student participation and critical reflection by engaging children participants in visual, auditory, and physical learning.


text:
Eliminating food assistance programs will do little to reduce obesity among poor Americans, according to UM-Dearborn Prof. Patricia Smith, who explores the issue in her new book
September 30, 2009
DEARBORN / Sept. 30, 2009---Obesity costs taxpayers billions of dollars each year in reduced labor productivity and increased medical expenses associated with Medicare and Medicaid, leading policy makers to seek ways to reduce obesity prevalence.
Since obesity is more prevalent among the poor than non-poor, some argue that public assistance programs like the Supplemental Nutrition Assistance Program (formerly called the Food Stamp Program) and National School Lunch Program contribute to weight gain and should be drastically revised or eliminated, says University of Michigan-Dearborn economics Prof. Patricia Smith.
But eliminating or cashing out food assistance programs will do little to reduce obesity among poor Americans, according to Smith.
Ive found theres no consistent evidence that either cash or food assistance contributes to weight gain among children and men, she says.
Smith used a multidisciplinary approach to explore the elevated risk of obesity among the poor in her new book, Obesity among Poor Americans: Is Public Assistance the Problem? published this summer by Vanderbilt University Press.
What Smiths research has found is that use of food stamps is consistently associated with higher weight among women, but its not clear why.
Food stamps may enable women to buy more calories or the once-a-month distribution schedule may lead to disordered eating patterns, tempting women to feast on calorie-dense comfort foods when benefits arrive at the beginning of the month and then fasting at the end of the month when benefits have run out, Smith explains.
However, food stamps contribution to obesity among the poor is minor, accounting for only about 5 percent of the cases of obesity among poor Americans, according to Smith.
The association could also arise because obesity tends to lower womens labor market outcomes and reduces their chance of marriage, making them more likely to be poor and eligible for public assistance, she says.
Smith also finds compelling evidence that poverty contributes to weight gain by limiting the poor to neighborhoods with reduced access to nutritious lower calorie foods, fewer facilities for physical activity and greater exposure to stressors such as crime and pollution.
In addition, childhood abuse, family violence and disability can increase both the risks of poverty and obesity, according to Smith.
The relationship between obesity and public assistance is complex and cant be explained as merely the result of assistance causing weight gain, she says. Thus, eliminating or cashing out food assistance programs will not effectively address the problem of obesity among the poor, but will increase their hardships.
Smith recommends increasing the frequency of food assistance distribution, expanding nutrition education programs, developing policies to increase access to nutritious foods in low income areas, and improving the nutrition environment in public schools.
"Understanding the reasons why the poor in general and the welfare-reliant in particular are more likely to be obese will help us design more effective policies to reduce obesity's high public and private costs," Smith says.
About University of Michigan-Dearborn
The University of Michigan-Dearborn is celebrating its 50th anniversary throughout the 2009/2010 academic year. Founded in 1959 with a gift of just over 200 acres of land and $6.5 million from the Ford Motor Company, UM-Dearborn has been distinguished by its commitment to providing excellent educational opportunities responsive to the needs of southeastern Michigan. The university has 8,700 students pursuing undergraduate, masters, doctoral and professional degrees in the liberal arts and sciences, engineering, business, education, and public administration. With a faculty devoted to teaching, and students committed to achievement, UM-Dearborn has been shaped by its history of interaction with business, government and industry in southeastern Michigan, and is committed to responding to the needs of the region in the future.
CONTACT: Tom Hoyt
The Office of University Relations
Room 1040, Administration Building
University of Michigan-Dearborn


text:
- olapic-scroller
Alice Demilune Console
- Overview
- The better half. With a traditional starburst veneer layout and a half-moon shape, our Alice Demilune Console is a design lover's dream. Constructed from weathered oak, it can be used as a space-saving desk in the entryway or as a circular table when paired together.
- 36"w x 18"d x 32"h.
- Weathered wood veneer in starburst design (on top surface).
- Engineered wood frame.
- Assembly required.
- Wipe clean.
- Imported.
- Details + Dimensions
- Overall product dimensions: 36"w x 18"d x 32"h.
- Clearance: 29".
- Number of boxes: 1.
- Shipping package: 39"w x 29.5"d x 5.5"h.
- Package weight: 32 lbs.
Wipe with soft dry cloth. Avoid the use of chemicals and household cleaners as they may damage the finish. Hardware may loosen over time. Periodically check that all connections are tight.
- Shipping + Return Info
Delivery Information
- Most purchases are shipped from our Distribution Center by UPS, to arrive in as little as 5 business days.
- Quick Ship fabric items receive delivery in 1 - 3 weeks.
- Special order fabric (SPO) items receive delivery in 8 -10 weeks.
- For our guide to measuring for delivery click here.
Shipping Rates
The shipping rate varies depending on your order total and shipping options. Please note, some furniture, rugs and other large items that are bulky or heavy items have a delivery surcharge listed in parentheses ($) after the item price. These delivery surcharges are in addition to the standard delivery shipping charges. View Shipping Rates and Options
Return Policy
We take great pride in the quality of our merchandise. If for any reason you are not happy with your purchase, you may return the item(s) within 30 days of receiving the order for a full refund of the merchandise cost. After 30 days, we will replace or refund your purchase against manufacturer's defects ONLY. Please note that we cannot accept returns on monogrammed/personalized items, special order upholstery items and special order rugs, one-of-a-kind rugs, or on items damaged through normal wear and tear. We also cannot accept returns of final-sale items, which are identified by a price ending in .99 or .97. Price adjustments will be honored within 14 days of purchase with original purchase receipt. Delivery fees are non-refundable. Returns of mattresses are subject to a $200 return shipping fee.
For further assistance please call our customer service department at 1.888.922.4119 or send an email to firstname.lastname@example.com


text:
Division of Aging and Community Services
Report to the Arizona Legislature
By the Auditor General
October 1995
Report # 95- 5
October 4, 1995
Members of the Arizona Legislature
The Honorable Fife Symington, Governor
Dr. Linda J. Blessing, Director
Department of Economic Security
Transmitted herewith is a report of the Auditor General, A Performance Audit of the
Department of Economic Security, Division of Aging and Community Services. This
report is in response to a May 5, 1993, resolution of the Joint Legislative Audit
Committee. The performance audit was conducted as part of the sunset review set
forth in A. R. S. § § 41- 2951 through 41- 2957.
This audit addresses Adult Protective Services' ( APS) ability to adequately protect
Arizona's adults. Our review of case files revealed that APS generally appears to
investigate all reports that warrant investigation, and does so in a timely manner.
However, APS' decentralized intake process, with intake performed at 30 separate sites
located throughout Arizona, fosters noncompliance with standards and inconsistent
case handling throughout Arizona. We recommend centralizing the intake function,
as other states have done, to eliminate these problems and improve APS' intake
function. We also found APS staff lack sufficient training. We recommend the Division
of Aging and Community Services adequately fund the development of a formal
training curriculum designed to help staff master APS- specific skills.
My staff and I will be pleased to discuss or clarify items in the report.
This report will be released to the public on October 5, 1995.
DOUR. NSort on
Auditor General
2910 NORTH 44Tn STREET m SUITE 410 . PHOENIX, ARIZONA 85018 l( 602) 553- 0333 m FAX ( 602) 553- 0051
The Office of the Auditor General has conducted a performance audit of the Arizona
Department of Economic Security ( DES), Division of Aging and Community Services in
response to a May 5,1993, resolution of the Joint Legislative Audit Committee. This audit,
the fifth in a series of six audits of DES, was conducted as part of the sunset review as set
forth in Arizona Revised Statutes ( A. R. S.) 5541- 2951 through 41- 2957.
The Aging and Adult Administration, within the Department of Economic Security's Di-vision
of Aging and Community Services, administers statewide programs of advocacy,
information and referral, and long- term care for the elderly. Adult Protective Services
( APS), within the Aging and Adult Administration, provides investigative and protective
services to Arizona's vulnerable and incapacitated adults. APS' statistics suggest that it is
adequately protecting Arizona's adults. Although only 73 percent of reports received al-leging
abuse, neglect, and exploitation are investigated, our review of case files revealed
that the 27 percent of reports not investigated probably do not warrant an investigation.
Further, APS staff initiated over 80 percent of investigations within 48 hours. In most of
the remaining cases, the client could not be located within this time frame and subsequent
attempts were made to locate the client. Finally, despite admirable efforts, APS staff often
have difficulty removing clients from risk because of clients' resistance or because needed
services are unavailable.
Adult Protective Services Should
Centralize Its Intake Function
( See pages 7 through 14)
APS currently performs intake at 30 separate sites located throughout Arizona. As a re-sult
of this fragmented intake process, workers do not always follow standard proce-dures
in performing intake and handle cases with similar characteristics inconsistently.
Case files lack necessary information regarding the extent of abuse, neglect, or exploita-tion,
and/ or lack sufficient documentation to support the decision to investigate a case.
Additionally, supervisory reviews are untimely, sometimes coming 8 to almost 12 months
after a case has been handled. As a result, not only is the potential for case mishandling
high, there is little chance mistakes will be identified and corrected. While only a few
cases appeared to be improperly handled, the potential exists for others.
Other states have implemented a centralized intake function after experiencing similar
problems and report that one intake location creates a more efficient, consistent intake
APS Lacks Formal Training
for Its Workers
( See pages 15 through 18)
New APS staff are required to handle cases without first receiving specific, job- related
training. Further, APS' ongoing training efforts do not provide sufficient training in the
skills necessary to conduct investigations, assess client needs, and find available services.
As a result, APS workers may not be adequately prepared to handle their challenging
caseload, placing workers and clients at risk.
In contrast, other states have developed or are currently developing training curricula,
generally including both initial and ongoing components. These states, recognizing the
benefits of adequate training, have formalized their processes by implementing training
requirements for their workers. Further, several states contract with firms or universities
to provide training, while also locating other effective training resources.
Arizona's Rapidly Growing Elderly Population
Could Overwhelm Already Burdened
Long- Term Care System
( See pages 19 through 22)
During the audit we also collected other pertinent information on the State's ability to
meet the long- term care needs of its rapidly growing elderly population. Unmet client
needs and growing budgets already burden Arizona's long- term care system. In fact,
over 1,000 clients were waiting for DES long- term care services in February 1995. Ex-pected
dramatic increases in Arizona's elderly population, almost 75 percent in the 85-
and- older population in just ten years, foreshadow increasing problems in meeting this
population's needs. Arizona may be able to identify more cost- effective ways to provide
long- term care services from other states. Washington, Oregon, and Wisconsin are able to
serve more clients with available service dollars by maximizing the use of less expensive
home- and community- based services.
Table of Contents
Introduction and Background ....................................................... 1
in din^ I: Adult Protective Services
Should Centralize Its Intake Function .................................... 7
The Intake Function ........................................................................................ 7
Intake Process Varies
Throughout State ............................................................................................
Centralization Could Improve
the Intake Process ........................................................................................... 10
Recommendations .......................................................................................... 14
Finding II: APS Lacks Formal
Training for Its Workers ......................................................... 15
Background ..................................................................................................... 15
APS Workers Lack
Task- Related Training .................................................................................... 15
DES Efforts Lag
Behind Other States ........................................................................................ 17
Recommendations .......................................................................................... 18
Other Pertinent Information .......................................................... 19
Arizona's Rapidly Growing Elderly
Population Could Overwhelm Already
Burdened Long- Term Care System ............................................................... 19
Area For Further Audit Work ......................................................... 24
Agency Response
Table 1 APS Reports Received
and Investigation Rates,
Fiscal Years 1991- 92 through 1994- 95 .................................. 2
Table 2 Percent Increase in Arizona's
Population from Current Year 1995. ................................ .... 21
The Office of the Auditor General has conducted a performance audit of the Arizona
Department of Economic Security ( DES), Division of Aging and Community Services in
response to a May 5,1993, resolution of the Joint Legislative Audit Committee. This audit,
the fifth in a series of six audits of DES, was conducted as part of the sunset review as set
forth in A. R. S. 5541- 2951 through 41- 2957.
The Division of Aging and Community Services ( Division) administers two types of pro-grams.
First, the Division, through its Community Services Administration, coordinates
several social service programs designed to meet the short- term emergency needs of Ari-zona
citizens such as homelessness and hunger. Second, the Division's Aging and Adult
Administration administers the Adult Protective Service ( APS) program and provides
services to the elderly including advocacy, information and referral, and home- and com-munity-
based care.
Adult Protective Services
Adult Protective Services ( APS) is responsible for protecting Arizona's vulnerable and
incapacitated adult population. APS staff receive reports alleging abuse, neglect, and ex-ploitation
of adults at 30 offices located in 6 districts throughout the State. After an inves-tigation,
workers attempt to remove people from risk by offering services, seeking guard-ians
or conservators, or, if necessary, involving law enforcement. However, unlike Child
Protective Services ( CPS), APS serves adults who, if they are mentally competent, have
the right to live as they choose, even if personal harm may result.
Despite statistics suggesting otherwise, APS staff are able to investigate virtually all cases
warranting an investigation. While APS staff also conduct timely investigations, they must
often overcome significant barriers to removing their clients from the risk they find.
APS statistics do not tell the whole sto y - APS' investigation rate is actually better than
its statistics suggest. As Table 1 ( see page 2) illustrates, APS received 10,219 reports in
fiscal year 1995 and investigated approximately 73 percent of them. However, during
intake, workers evaluate all reports to determine if they require a field investigation.
Reports that identify alternative sources of help, lack sufficient information to identify a
client, or involve clients already known to APS may not be investigated. In these cases,
APS staff may be able to provide sufficient assistance at the time the report is taken. Our
review of APS cases confirms the 27 percent of cases not investigated probably did not
warrant a field investigation.
Table 1
APS Reports Received and Investigation Rates,
Fiscal Years 1991 - 92 through 1994- 95
Total Reports 8,979 9,205 8,974 10,219
Reports Investigated 6,660 6,531 6,331 7,417
Reports Not Investigated 2,319 2,674 2,643 2,802
Investigation Rate 74.17% 70.95% 70.55% 72.58%
Source: Statistical reports from APS' automated data system.
APS initiates the majority of its investigations within the required 48- hour time frame. In
fact, APS staff initiated investigations within 48 hours in 80 percent of the cases we re-viewed.
In most of the remaining cases, the client could not be located within this time
and subsequent attempts to locate the client were made. This time frame is quicker than
that used in several other states, which allow up to ten days to contact certain clients.
APS stag often unable to help clients - After an investigation, workers often face barri-ers
in removing clients from risk. In many cases, clients themselves present the greatest
barrier to workersf efforts, as many are unwilling to accept APS' assistance. The majority
of APS cases are neglect cases, involving clients who fail to take care of themselves. Many
of these clients refuse to make the lifestyle changes necessary to alleviate their situation,
despite the consequences. Even clients who have been abused or financially exploited by
relatives and friends are sometimes reluctant to take action against the perpetrator. How-ever,
APS cannot coerce mentally competent clients into accepting assistance. An adult's
right to live as he or she chooses is foremost, and is to be considered before safety and
Through our case review, we identified many cases involving uncooperative clients who
were unresponsive to APS assistance. cl) In over half of the cases reviewed clients refused
any APS assistance. Some of these clients insisted they had no problems for APS to re-
(') We randomly selected 150 APS cases open between ~ u19l94 t~ hro ugh February 1995. In each case the
client was a female, 60 years of age or older, which is the typical APS client. Ninety cases involved
allegations of neglect, with 30 each from Districts 1 and 2, covering Maricopa and Pima Counties
respectively, and 30 additional cases from Districts 3 through 6, which cover the remainder of the
State. We also reviewed 30 cases with allegations of abuse, and 30 with allegations of exploitation,
from all 6 districts.
solve, even though the reporting source stated otherwise. Others flatly refused to con-sider
the worker's suggestions, allowing themselves to physically deteriorate. For ex-ample:
One client allegedly lived in her car and slept in her backyard, without water or elec-tricity
in her home. A worker twice attempted to visit the client, but was unable to
contact her. To obtain additional information, the worker called the reporting source
who stated that although the client was competent, she was a poor housekeeper. Later
the client herself called APS and declined any APS assistance, explaining she was too
busy for APS' help as she volunteered at five different agencies.
APS investigated a reportedly bedbound client receiving home health services and
improperly taking her medications. The referral source also alleged that although the
client needed long- term care, her son refused to help her apply for i t When the worker
determined that the client would benefit from more care and supervision, possibly
from a nursing home, the client adamantly disagreed. After the worker made a sec-ond
visit and again tried to convince the client to move, the client reiterated her oppo-sition.
The worker closed the case, since the client was competent and refused APS'
Workers' dependence on other programs to provide services also hinders their ability to
impact clients. Although APS is responsible, by statute, for offering services to its clients,
APS is not funded to directly provide them. Workers have access to the APS emergency
budget to meet immediate client needs such as emergency lodging or nursing services;
however, funds are limited. On average, each of the 6 districts is allocated only $ 28,000
per year. In addition, workers must prove the funding needed is a " last resort." As a
result, workers must rely on other programs to provide clients with services such as per-sonal
care and housekeeping. However, extensive waiting lists exist for these services, or
they are simply unavailable. This is especially true in the rural areas of the State, where
workers shared their frustrations with the lack of mental health, transportation, and other
services for the elderly.
Budget and Personnel
The Department of Economic Security's Division of Aging and Community Services was
appropriated $ 16.4 million in state dollars for fiscal year 1996. Over half of this, $ 9.0 mil-lion
in state funds, along with $ 37.4 million in federal and local funds, will be used to
provide services for the elderly and physically disabled adults, $ 3.6 million will be used
for Division operating costs, and another $ 3.6 million is designated for the Community
Services Administration's programs. Additionally, $ 176,100 in state funds are allocated
to APS to provide emergency services.
Aging and Adult Administration is authorized 156 full- time equivalent positions in fiscal
year 1996,75.4 of which are state funded. The majority of staff, 104, are APS workers and
administrators that are located in 6 districts throughout the State. The remaining 52 Ag-ing
and Adult Administration staff are located in the central office and perform a variety
of functions. Staff oversee provider contracts, coordinate the State's Older Worker pro-grams,
develop and maintain policies and procedures, and handle the Division's busi-ness
and information functions.
Scope and Methodology
Our audit focused on Adult Protective Services. We interviewed Aging and Adult Ad-ministration
and APS management and elder advocates, spent time with numerous APS
workers observing the intake and investigative process, conducted extensive case file
reviews, and contacted nine states to draw comparisons with their adult protective ser-vice
systems.( l)
During the preliminary phase of the audit, we interviewed several service providers,
planning agencies, and people familiar with the Division's Community Services
Administration's ( CSA) practices, and determined that they were generally satisfied with
CSA's performance. In addition, the majority of CSA's programs are federally funded.
Further, this money is passed through CSA to local agencies for the actual provision of
services. For these reasons, we chose not to concentrate on CSA's responsibilities during
the audit, and instead focused our efforts on Adult Protective Services.
This audit contains findings and recommendations in two areas:
H the potential for case mishandling during the APS intake process due to workers not
following standard procedures consistently, and
H the unmet training needs of APS workers.
Concerned about the growth in Arizona's elderly population, we also studied the State's
elder service system and its ability to meet current and future client needs. We inter-viewed
officials at agencies providing services to the elderly, reviewed literature, and
studied long- term care systems in several other states, including Washington, Wisconsin,
We contacted Texas, I h o i s , Virginia, Nebraska, Maine, Utah, Kansas, Missouri, and New Mexico.
These states were mentioned during the audit as being innovative in at least one aspect of providing
adult protective services.
and Oregon, recognized leaders in long- term care policy and service delivery. This audit
also presents other pertinent information on Arizona's ability to meet the long- term needs
of its rapidly growing elderly population.
This audit was conducted in accordance with government auditing standards.
The Auditor General and staff express appreciation to the Director of the Department of
Economic Security, the Assistant Director of the Division of Aging and Community Ser-vices,
and their staff for their cooperation and assistance throughout the audit.
Adult Protective Services' ( APS) decentralized intake system fosters noncompliance with
standards and inconsistent case handling throughout the State. Furthermore, supervisory
review of the intake process is not possible at all APS offices, and when possible, often is
untimely. As a result, the potential for case mishandling is high and errors may go unde-tected,
thereby exposing the State to liability. Centralizing the intake function, as other
states have done, could eliminate these problems and improve APS' intake function. Ad-ditionally,
APS could further improve its intake process by prioritizing reports for inves-tigation.
The Intake Function
During intake, APS workers at 30 offices statewide receive reports of abuse, neglect, or
exploitation of adults and provide information and referral services. APS classifies intake
calls into two categories: 1) Reports and 2) Information and Referral ( I& R). Of the 18,668
calls APS offices received in fiscal year 1995,54.7 percent were Reports involving allega-tions
of abuse, neglect, or exploitation of an adult and the remaining 45.3 percent were
I& Rs. I& Rs represent calls from people needing only information or assistance in gaining
access to various social services, such as the programs offered at the nearest senior center,
or how to apply for social security.
APS Reports are further classified into reports accepted for investigation and reports not
accepted for investigation, termed Assess and Review cases ( A& Rs). Almost three- quar-ters
of all Reports ( 72.6 percent) are investigated. Cases are not investigated when there is
insufficient identifying information, other people or agencies are available to help the
individual, or APS has already investigated the case and no new information is presented.
The intake function serves two purposes. First, intake permits the APS worker to screen
out calls that do not meet the established criteria for abuse, neglect, or exploitation. Sec-ond,
for those cases meeting the criteria, intake represents the first opportunity to obtain
valuable information that can help determine how a particular case should be handled.
Intake Process Varies
Throughout State
In performing intake, APS workers do not always follow standard procedures and may
handle similar cases differently. This can lead to case mishandling, potentially placing
clients at risk, and exposing the State to liability.
Standard procedures not followed - A review of A& R and Report case files revealed that
the documentation within the case files is inadequate and not in compliance with the APS
Policies and Procedures Manual ( Manual). l According to APS management, the Manual
provides workers direction in screening calls and verifying that APS clients meet statu-tory
eligibility criteria. It contains specific guidelines for performing intake, including a
list of questions intake workers should address, such as how long a problem has existed,
the degree of urgency, the client's functional level, and if assistance is being provided by
other agencies or individuals. Also, the worker is to elicit specific information regarding
the allegation of abuse, neglect, or exploitation. Once obtained, the worker can use this
information to determine if a report should be investigated.
Unfortunately, APS workers often disregard many of these requirements. Overall, 60 per-cent
of the cases reviewed were not handled in accordance with the APS Manual during
intake. For example:
Approximately 40 percent of the cases lacked documentation explaining the extent of
abuse, neglect, or exploitation, or the situation's urgency. One case involving a men-tally
retarded woman who was allegedly being exploited by her payee ( person desig-nated
by the Social Security Administration to receive an individual's social security
checks and pay his or her bills), lacked information on what led the caller to suspect
exploitation. The file did not even include the alleged perpetrator's name. In another
case, a caller feared for the safety of a client who was leaving a care center. The center
would not provide follow- up services at the client's home because it was unsafe. How-ever,
the file did not include information on why the situation was deemed unsafe,
possibly exposing the assigned investigator to unknown danger.
Additionally, 47 percent of the cases lacked documentation detailing the worker's
efforts in determining what, if any, services the client may be receiving from other
agencies, groups, or individuals. This information is specifically needed to determine
if a case should be investigated.
Sixty randomly selected cases, 30 A& Rs and 30 Reports, were selected for review. Cases selected were
active between July 1994 and February 1995.
Timely supervisory review of cases could increase the likelihood that Manual policies are
followed. According to the Manual, Reports are to be reviewed by a supervisor within
one month of completion; however, there is no policy on supervisory review of A& R's.
Yet supervisory review of A& R's, completed directly following intake, is critical to en-sure
a case warranting an investigation is not overlooked. One month, the policy for Re-ports,
may be too late if a case should have been investigated. ( APS recently changed its
policies and now requires A& Rs be reviewed within 48 hours.) However, we noted that
approximately 17 percent of A& Rs we examined were not reviewed by a supervisor even
within 1 month. We found one A& R case that was still open over a year after it was
resolved, waiting for supervisory review. Other cases were waiting for reviews from one
and a- half months up to eight months. Also troublesome, nowhere in the case files were
there supervisory review comments, notations, or questions regarding the cases, raising
questions about the quality of the supervisory reviews.
Cases handled diflerently throughout State - Several inconsistencies also result from
performing intake at many offices throughout the State. First, staff performing intake at
each site have varying levels of experience. While Human Service Specialists I11 ( investi-gators),
the most experienced staff, usually perform intake, they are not always available.
Many rural offices have only one investigator and when they visit a client or are in Phoe-nix
for training, a less experienced staff member, a secretary, a DES employee from an-other
division, or even an answering machine takes calls.
Second, similar intake calls, even when received by investigators, can be handled differ-ently.
This problem, raised by Aging and Adult Administration management and APS
staff during the audit, was confirmed while monitoring the intake function at several APS
offices. For example, the following case example was noted at one site:
A client called APS two times with the same information, requesting assistance each
time. The first call was handled by an APS worker who was new to the office, and was
classified as an A& R. The second call was received by an APS worker with 13 years of
related protective services experience, who classified the call as a Report and plans to
conduct an investigation and offer services. She stated that she assessed the situation
differently than her colleague because she has more experience and training.
Additional inconsistencies identified include:
APS workers obtain and document information differently. For example, some work-ers
take notes manually and enter the information onto the APS computer system at a
later point in time, sometimes days or weeks after receiving the call. Such delays may
prevent the worker from remembering key facts pertaining to a case that are not writ-ten
down. On the other hand, some workers simultaneously receive calls and enter
the information received into the APS computer system.
APS offices operate with different levels of supervisory review. For example, urban
offices have supervisors available to review all cases immediately after intake and
assign those requiring an investigation to the appropriate staff. However, rural offices
allow APS workers to assign cases for investigation ( usually to themselves) without
supervision, as a supervisor may have to cover APS offices in several counties and
visit offices only once a month.
Weaknesses may result in case mishandling - For the most part APS staff accurately
determine which cases require an investigation; however, weaknesses in the intake sys-tem
have led to a few instances of apparent case mishandling. First, APS may have inves-tigated
cases not warranting one. In 37 percent of cases reviewed, there was insufficient
documentation in the case files to determine whether an investigation was warranted.
More importantly, there were several cases that appeared serious enough to warrant an
investigation, but none was conducted. These cases involved the physical abuse of an
elderly woman by her son, a drug user; and exploitation of a mentally retarded woman
by her payee ( mentioned earlier). Further, one case involved a referral from a social ser-vice
provider who called numerous times stating that a client's medical condition was
getting increasingly worse. The APS worker decided during intake that the case should
not be investigated, yet the individual was hospitalized a week later. After reviewing
these specific cases, an APS official believed in one case, involving the woman abused by
her son, that the worker appropriately referred the reporting source to community legal
services, as the woman was deemed competent. However, he had difficulty determining
if the remaining two cases should have been investigated due to the lack of documenta-tion
in the case files.
APS caseloads will probably increase due to Arizona's growing elderly population ( see
pages 19 through 21), thus it may only be a matter of time until serious tragedy such as
permanent injury or even death results from case mishandling. Should this occur, the
State may be held responsible. The State is usually liable for its negligence, defined as
breaching a duty which proximately causes any injury or damage. Because APS holds a
duty to provide adult protective services to eligible adults within a reasonable amount of
time after notification, breaching that duty would place the State in a vulnerable position.
Centralization Could Improve
the Intake Process
Centralizing the intake function could reduce noncompliance with standards and incon-sistent
case handling. States with a centralized APS intake system have been able to over-come
these problems. Additionally, in Arizona, the new Centralized Intake Unit in DES'
Child Protective Services Division provides significant benefits to the intake process.
hprovements result through centralization - A centralized system, by its nature, ad-dresses
the current problems in several ways:
First, one location offers increased monitoring capabilities. Monitoring and supervi-sory
review activities can be facilitated at one location, creating better opportunities to
enforce compliance with the APS Manual.
Second, centralization encourages specialization. As the staff in the centralized intake
unit perform only one function, they ultimately become " resident experts" on intake.
Finally, centralization limits the intake function's drain on resources, allowing APS
workers to better meet clients' needs. One APS worker stated she spent more than 60
percent of her time handling phone calls unrelated to legitimate APS cases. The staff
located throughout the State will no longer be burdened with the task of performing
intake, significantly increasing the time available to address client needs.
In agreement, one APS supervisor stated the ideal intake function would have all intake
personnel in one room, in one location where they could ask each other questions while
receiving calls to ensure cases are classified and handled correctly. He believes the cur-rent
system with many different people performing intake in separate offices limits staff's
ability to solicit advice or information from fellow intake staff.
Other states realized benefits subsequent to centralizing intake - Several states, includ-ing
Florida, Missouri, Texas, and Utah, have centralized or are in the process of centraliz-ing
their intake function.(') For example, Missouri's APS operation, which received over
19,000 reports in fiscal year 1994, implemented its central intake unit in 1980. One Mis-souri
official stated that centralization improved consistency and efficiency as staff per-forming
intake become experts in this area and local staff can spend more time investigat-ing
cases and offering protective services.
Operationally, Missouri's central intake unit receives all calls, statewide, regarding alle-gations
of abuse, neglect, and exploitation. A toll- free hotline is manned 24 hours a day
by 16 staff. Intake forms are faxed to the local office where the client resides for investiga-tion.
However, the central intake does not prevent people from calling the local offices.
Approximately 20 percent of their total calls still come into the local offices.
Utah's APS operation, considerably smaller than Arizona's ( 2,425 reports received in fis-cal
year 1994), consolidated intake into three intake sites in May of 1995 and recently
proposed further centralizing their intake function into one state intake unit. In the old
decentralized operation, where intake occurred in numerous cities throughout the State,
Maine has a centralized intake unit which operates during non- business hours. Local offices perform
intake Monday through Friday from 8: 00 am to 5: 00 pm.
workers were not available 24 hours a day, or even during business hours while conduct-ing
investigations, leaving callers talking to answering machines. Utah officials argued
that having one location would be more efficient, bring consistency to the intake process,
and allow increased intake coverage.
CPS is experiencing benefits through centralization - Within DES, Child Protective Ser-vices
( CPS) implemented its Centralized Intake Unit to improve consistency in report
screening and prioritization. CPS determined its fragmented intake system led to a high
number of callbacks, too many people performing duplicate functions, and misinterpre-tation
of policies, procedures, statutes, and regulations. Calls that should have been in-vestigated
were not and others were needlessly assigned for investigation. Therefore,
CPS centralized its intake function, and has reaped the following benefits:
consistency in performing intake functions,
limited and focused training requirements,
simplified monitoring of compliance with policies, procedures, statutes, and regula-tions,
more time for investigators to conduct investigations and meet client needs, and
timely entry of data onto the system.
APS management recognize benefits of centralization - The Division of Aging and Com-munity
Services ( Division) and APS management at the time of this audit agree that cen-tralization
could improve APS' intake function. These management officials echoed the
sentiments registered by other states, citing consistency, more time for investigators in
the field to handle their caseload, and increased intake coverage as benefits from such a
The primary concern with centralization registered by Division and APS officials cen-tered
on the information and referral function. Should intake become centralized, the
rural offices will no longer provide information and referral services, leaving residents
without a convenient source of information on local services. However, the information
and referral responsibility may not appropriately belong with APS. Instead, the State's
eight Area Agencies on Aging ( Area Agencies) should provide these services.(') Despite
having fewer offices than APS, the Area Agencies are designated as regional elder plan-ning
and service centers and should be able to provide the same assistance currently
DES contracts with eight Area Agencies on Aging to coordinate providing the majority of services for
the elderly.
provided by APS staff. In fact, when asked if they could assume this responsibility, sev-eral
Area Agency representatives stated that, given additional resources, they would pre-fer
to handle information and referral calls, maintaining that APS should be an emer-gency
responder specifically addressing crisis situations. One Aging and Adult Adminis-tration
official agreed with the transfer of APS' information and referral role; stating,
however, that it will take additional resources for the Area Agencies to handle these calls
and time before people get used to calling another agency for assistance.
Other states prioritize cases to further improve APS seruices - During the audit, we also
collected information on report priority systems used in other states to identify cases
needing immediate attention. Although APS is currently able to initiate most investiga-tions
within the established 48- hour time frame, given the probable future increase in its
reports, APS may need to prioritize cases during intake in the future. Additionally, a
priority system could allow complicated cases to receive more investigative resources.
Several states have systems in place to ensure that cases presenting the most risk are
investigated first.@ M) oreover, workers can take more time to start investigations involv-ing
less risk. For example:
Nebraska assigns each case during intake to one of three categories: Priority 1 are the
highest risk cases and require the worker to contact the client within eight hours.
Priority 2 cases involve less risk and require contact within five days. Priority 3 cases,
involving the least risk, require contact within ten days.
Missouri, similar to Nebraska, assigns reports to one of three classes. However,
Missouri's Class 3 reports, which require no immediate protective services, may not
involve the worker contacting the client.
Kansas' APS also assigns priority levels to cases. In cases where clients are in immi-nent
danger, workers must make the initial contact within 24 hours. However, if the
client is allegedly abused and not in danger, the worker has three days to contact the
client. Finally, the worker has five days to contact the client if neglect or exploitation is
alleged and the client is not in danger.
Of the nine states we contacted, seven have priority systems: Nebraska, Maine, Kansas, Missouri,
Illinois, New Mexico, and Texas prioritize cases.
1. The Division should consider centralizing the intake function to better enforce com-pliance
with APS policies and to ultimately ensure appropriate decisions are made for
each case.
2. APS should strengthen its supervisory review process, including enforcing more timely
supervisory reviews.
3. APS should consider implementing a case prioritization system for investigated cases
to ensure those needing immediate attention are investigated first.
Currently, Adult Protective Services ( APS) staff are required to handle cases without first
receiving specific, job- related training. As a result, APS workers may not be adequately
prepared to handle their challenging caseload. To improve the preparedness of APS work-ers,
the Division should follow other states' lead and adequately fund development and
implementation of a formal training curriculum.
Although many APS workers come to the Division with extensive social service experi-ence,
either through education and/ or work with other organizations, the nature of some
APS work requires specific training. In fact, several APS staff we interviewed commented
that their formal education in social work proves deficient in certain situations, magnify-ing
the importance of formal training specifically directed toward APS work. For ex-ample,
they may not have the necessary knowledge of 1) accounting, bookkeeping, or
legal practices to prepare them for exploitation cases, or 2) photography or physical indi-cators
to assist in the substantiation of abuse and neglect cases. Additionally, workers
may not be sufficiently trained in the unique needs and problems of the elderly, APS
primary client. Finally, certain rural offices have difficulty finding people with college
degrees to hire.
APS Workers Lack
Tas k- Related Training
Despite needing additional training once they are hired by APS, workers receive no for-mal,
specific, job- related training prior to taking on a caseload. In addition, APS ongoing
training efforts do not sufficiently provide task- related information to its workers. In the
absence of adequate training, learning these skills occurs on the job. As a result, inconsis-tencies
have developed and APS clients are potentially at risk.
No formal initial staff training - Interviews with several workers revealed that the
districts do not sufficiently train staff prior to assigning them cases and some do not
provide any training at all. For example, on the first day of employment, a worker in one
office went through an orientation covering basic office tasks such as preparing time sheets
and answering the phone. After the orientation, the worker was required to handle an
actual case, because no other APS staff were available. The worker described her experi-ence
as " baptism by fire.'"
Staff also receive an APS Manual when starting, but the Manual alone does not adequately
prepare workers to perform their jobs. Several APS worker commented that reading the
Manual provides little help in dealing with the unique real- life situations APS workers
encounter. For example, the Manual states the staff should evaluate the physical and mental
condition of potential victims to substantiate abuse or neglect. However, the Manual lacks
specific details regarding what types of injuries indicate abuse or neglect or what mental
conditions lead to substantiated cases.
In- service training - In- service training is also inadequate. Currently, the Division limits
ongoing training efforts to quarterly training conferences. These conferences, which gen-erally
last one or two days, are not mandatory, and do not occur prior to APS workers
handling cases. Moreover, the training conferences often lack specific job- related or task-oriented
While attending one of these training conferences, we noted that the entire first day of the
two- day conference was spent discussing the activities of the APS workers' committee,
employee evaluations, and other administrative topics. In addition, a review of training
agendas for several other conferences revealed that the topics did not often relate to daily
APS activities. Examples of topics covered at these conferences include: Managing Life at
Work, Advocacy for the Disabled, and Humor in the Workplace.
The APS Training Coordinator stated that skill- based training aimed at teaching APS
workers how to properly perform their jobs is often neglected. APS workers agreed that
specific training in APS related skill areas is needed most. For example, one APS worker
" I hate exploitation cases because I have no experience, expertise, or power. Instead, the
banks, attorneys, ... and perpetrators have all the knowledge, power, and control. Being at
such a disadvantage puts me in a no- win situation because I lack the knowledge and confi-dence
to deal with these parties and therefore cannot help my client. Only training specifi-cally
on accounting, banking, the law, and similar topics would improve how I handled
these cases. Unfortunately, such training does not currently exist."
Poor training potentially causes problems - The current method of placing employees
in the field without training prevents consistency in following APS policies. One APS
official stated that a training program teaching workers how to handle APS cases in ac-cordance
with APS policies could eliminate much of the inconsistency in classification
and case handling as noted in Finding I. Further, on- the- job training also potentially re-sults
in workers not learning how to handle certain situations, such as dealing with alco-holic
clients or those with serious mental illness, until they involve actual cases. Unpre-pared
workers place both themselves and clients at risk. One worker related her experi-
ence conducting an investigation in a nursing facility, which involved reviewing client
records. Not trained in interpreting medical records, nor the record- keeping requirements
of licensed nursing facilities, the worker was unable to quickly understand the client's
condition and help remove the client from risk.
DES Efforts Lag
Behind Other States
While several other states utilize a formal training curriculum to train their adult protec-tive
service workers, Arizona's APS unit only recently acknowledged the importance of
more formal training by hiring a training coordinator. However, inadequate funding still
hampers progress in this area.
Other states - Unlike Arizona, six of the nine states we surveyed, including Texas, New
Mexico, Virginia, Illinois, Nebraska, and Utah, have training curricula and the other three
are currently developing them. The training curricula vary but most include both manda-tory
initial and in- service training components. Some training curriculum characteristics
training topics such as how to conduct intake and investigations, develop case plans,
and identify mental disorders and client exploitation,
mandatory hourly training requirements for all APS workers,
initial training components lasting from 1 week ( 40 hours) to 2 weeks ( 80 hours), and
W requirements for APS workers to pass an exam upon completion of the initial staff
These states effectively utilize a myriad of resources to provide sufficient training to their
workers, including their own training units with specialized APS trainers, consulting
firms, and local universities. Some states effectively use a training coordinator and com-mittee
to organize, arrange, and evaluate the training being offered and make changes
when necessary. Others use " experts" such as lawyers, police officers, doctors, psycholo-gists,
nurses, university professors, and professional trainers to provide information and
Recent, limited improvements in APS training - APS has not emphasized or devoted
resources to training in the past. In fact, APS has not designated training funds in many
years, and still no funds have been set aside for fiscal year 1996. Instead, money needed
for the training conferences, such as renting meeting space and hiring speakers, must
come out of other areas of APS' operating budget.
Additionally, prior to fiscal year 1995, APS did not have a training coordinator to develop
initial staff training and improve in- service training. While a new training coordinator
was hired in the fall of 1994, her responsibilities have been expanded to include coordi-nating
training for the entire Aging and Adult Administration. Despite having limited
time for APS, the new training coordinator has taken several steps to improve its training.
For example, she has
worked with DOA to provide additional training to APS workers,
corresponded with several other states regarding their training curricula,
contacted the National Institute for Human Services in Ohio regarding its services to
assist states in developing training curricula,( l) and
requested APS conduct a training needs assessment to define workers' needs.
1. APS should develop and implement a formal training curriculum designed to help
staff master APS specific skills such as conducting investigations and assessing client
needs. The curriculum should include both a mandatory initial training component
for all new APS staff and ongoing training sessions.
2. The Division of Aging and Community Services should adequately fund the develop-ment
and implementation of a formal training curriculum.
The National Institute for Human Services developed DES' Administration for Children, Youth, and
Families training curriculum.
Other Pertinent Information
During the audit, we developed other pertinent information on the State's ability to meet
the long- term care needs of its rapidly growing elderly population.
Arizona's Rapidly Growing Elderly
Population Could Overwhelm Already
Burdened Long- Term Care System
Unmet client needs and growing budgets burden Arizona's long- term care system for the
elderly and physically disabled. Expected dramatic increases in Arizona's number of eld-erly
persons foreshadow increasing problems meeting this population's long- term care
needs. Arizona can learn from three states leading the development of more cost- effective
ways to serve this population.
Ovemhelmed long- tenn care system - While both the Department of Economic Security
( DES) and Arizona Health Care Cost Containment System ( AHCCCS) provide long- term
care services, AHCCCS' long- term care budget has grown dramatically in recent years,
and DES cannot provide long- term care services to all eligible clients. AHCCCS provides
nursing home and home- and community- based services such as adult day care, and
homemaker and personal care services, to approximately 12,000 low- income elderly and
physically disabled adults through the Arizona Long- Term Care System ( ALTCS). ALTCS
has experienced significant growth since its inception in 1988. In fact, its budget has more
than doubled in the last seven years, and now totals over $ 370 million for fiscal year
1996.( l)
DES, through the Aging and Adult Administration's Non- medical Home and Commu-nity-
Based Care System, serves individuals with fewer functional impairments and more
resources than those eligible for ALTCS. DES long- term care services include housekeep-ing,
nurse, and home health aid visits, home- delivered meals, and adult day care. How-ever,
DES' program, spending over $ 20 million on services for approximately 18,000 cli-ents
in fiscal year 1995, has extensive waiting lists.( 2) I n February 1995, approximately
1,100 individuals were waiting for DES long- term care services. Although DES received
additional funding for its home- and community- based program for fiscal year 1996, Aging
and Adult Administration officials believe it will provide services for approximately one-fourth
of the waiting list clients.
ALTCS will receive $ 246.3 million in federal Medicaid in fiscal year 1996. T11e counties provide the
entire state match of $ 126.2 million.
( 2) The $ 20.4 million in service dollars used in fiscal year 1995 was comprised of $ 8.6 million in state
appropriations and $ 11.8 million in Older American's Act funds.
Growing elderly population - Increases in Arizona's elderly population will further
burden the long- term care system. Arizona currently ranks second in the nation, behind
Hawaii, in the increase of the 65- and- older population between 1990 and 2000. This group
currently represents 14 percent of Arizona's total population. Additionally, the 85- and-older
segment of Arizona's elderly population is expected to grow by almost 38 percent
in the next 5 years. This segment is significant as individuals over 85 are most likely to
need long- term care. As Table 2 shows, the rapid growth in both groups continues 10,15,
and 20 years into the future. In fact, the 65- and- older segment is expected to represent
over one- sixth of Arizona's total population by 2020.
Percent Increase in Arizona's Population
from Current Year 1995
Year 2000 2005 201 0 201 5
Total Pop. I + 12.5% + 24.5% + 36.6% + 49.3%
Age 65+ El + 14.8% + 28.0% + 45.9% + 74.0%
Age 85+ + 37.7% + 74.5% + I 15.4% + 141.6%
Source: Auchtor General analysis of DES' Arizona population projections 1995 to 2045.
Other states finding solutions - Florida also faces a rapidly growing elderly population.
One former Florida senator sees long- term care for this population as the " black hole" of
state government. A Department of Elder Affairs official stated:
" The challenge to states is to build a system that targets scarce state resources to the right
mix of institutional, residential, and community long- term care. In an age of high de-mands,
it is critical that we provide long- term care in the least expensive setting, which, at
the same time, provides the level and quality of services that people need."
Three states, Oregon, Washington, and Wisconsin, have already developed ways to serve
more clients with the federal ( Medicaid) and state dollars available by consolidating pro-grams
and maximizing the use of less expensive home- and community- based services.
In Oregon, one agency administers both the Medicaid and state- funded programs. Offi-cials
believe consolidation has been instrumental in developing a comprehensive long-term
care system. Additionally, all three states attempt to place as many people as pos-sible
in less expensive home- and community- based settings, while at the same time lim-iting
the number of nursing home beds. Washington's overall priority is to aggressively
battle nursing home growth; as one official stated, " a built bed is a filled bed." Further,
Oregon actively promotes alternative living arrangements that are less expensive and
restrictive than nursing homes, but provide more care than can be given at a client's home.
During the course of our audit, we identified an issue we were unable to fully pursue at
this time.
Is duplication and overlap among agencies serving the elderly adversely impacting
access to services? The Department of Economic Security's Aging and Adult Administra-tion
and the Arizona Health Care Cost Containment System's Arizona Long- Term Care
Systems ( ALTCS) have separate entry points for their services for the elderly; however,
an individual may not know which program he or she qualifies for and therefore where
to go first. The Aging and Adult Administration utilizes local case management agencies
throughout the State to authorize services. ALTCS also has eligibility offices located in
several cities throughout the State. Adding to the confusion, individuals can also enter
the system through Adult Protective Services ( APS), and then be referred to ALTCS or a
case management agency.
Moreover, simply obtaining information may sometimes be difficult, requiring several
phone calls, as information and referral services are also dispersed among many agen-cies.
In fact, at least three separate places provide information and referral in Maricopa
County. The Area Agency on Aging ( Area Agency) sponsors a Senior Help Line, the local
case management agency provides information and referral at its central intake line, and
APS also currently provides this service. Despite so many sources of information, indi-viduals
may still not get the help they need. Several people interviewed during our audit
stated that any single referral source lacks information on all available services. Transfer-ring
information and referral services from APS to the Area Agency as suggested in Find-ing
I could allow the Area Agency to take the lead in providing information and referral
Perhaps further inconveniencing clients, each agency uses a separate assessment instru-ment
to determine eligibility and client needs. Although Aging and Adult Administra-tion
and ALTCS' assessment instruments are similar, they are not used interchangeably.
For example, ALTCS requires an assessment for eligibility and possibly another to iden-tify
service needs. The Aging and Adult Administration also conducts its own assess-ment.
Unfortunately, both most likely reassess individuals referred from the other pro-gram.
Additionally, APS assesses its clients for risk and if ongoing needs are identified, it
refers them to ALTCS or an Aging and Adult Administration case management agency,
and the cycle continues. The following case example illustrates how confusing this can be
for the client:
A one- hundred- year- old man who has been falling down and is mentally incapaci-tated
was assessed by an APS worker who determined the client needed housekeep-ing
and bathing services and home- delivered meals. Yet, the Aging and Adult
Administration's locally contracted case manager had to reassess the client before au-
thorizing any of these services. The client also needed a guardian or conservator, so
meanwhle the public fiduciary's office conducted its own assessment. The client was
also assessed by ALTCS for financial eligibility. As a result of so many assessments,
the client is frustrated and confused, and even fired the people who finally came to
provide services.
Other states utilize a single entry point and uniform assessment instrument to improve
access to services. In Wisconsin, counties are responsible for providing all long- term care
services. County case managers assess client needs and authorize services from any fund-ing
source. Further, Washington utilizes a standard assessment instrument for its long-term
care program. Despite having two agencies providing services, like Arizona, these
agencies share assessment results and every effort is made to ensure a second assessment
is never conducted.
Further audit work is needed to determine the extent of the problem and the possibility of
developing a uniform assessment instrument.
Agency Response
1717 W. Jefferson - P. 0. Box 6123 - Phoenix, AZ 85005 ( Fife Syrnington Linda J. Blessing, DPA
Governor SEP 2 9 1995 Director
The Honorable Douglas R. Norton
Auditor General
Ofice cf the Aditor Generzl
2910 N. 44th Street, Suite 410
Phoenix, AZ 850 18
Dear Mr. Norton:
Thank you for providing the preliminary draft report of the performance audit of the Department of
Economic Security, Division of Aging and Community Services. My staff and I are pleased to see
that your findings are consistent with the direction we have taken to continually improve our ability
to protect older and disabled adults and to plan for the future influx of older persons requiring our
DES concurs with your findings and recommendations and will work with the Division of Aging
and Community Services to establish and implement, to the extent that our resources will allow, the
knctions and procedures listed below:
1) Centralize the intake function in order to:
* Ensure consistent intake procedures are followed throughout the state,
* Simplify the interpretation and monitoring of compliance with policies, procedures,
rules and laws,
* Relieve field investigators of the intake function in order to increase time devoted to
investigating reports and offering needed protection to vulnerable and incapacitated
adults, and
* Ensure that consistently appropriate decisions are made regarding whether or not to
investigate an incident report involving a vulnerable adult.
2) Enhance the supervisory review process to ensure that report decisions and case reviews are
conducted in a thorough and timely manner.
3) Prioritize case investigations in order that APS can immediately respond to situations that
are life threatening, or affect the health or safcty of vulnerable adults.
Page 2 SEP 2 9 1995
4) Provide core and ongoing training for all APS workers. We consider training to be the
cornerstone of our improvement strategy. Toward that end, the Department has identified the
need for funding to develop competency- based, core and on- going training.
5) Continue to work closely with the Governor's Ofice, the Legislature and affected state
agencies to encourage needed coordination andlor integration of planning, programming and
administration of Long- Term- Care ( LTC) and other programs for the elderly. This
cooperation is essential given the fact that Arizona's rapidly growing elderly population will
continue to stress the already burdened LTC system.
This report is thorough and objective and will undoubtedly prove to be helpful in continuing to
improve protective and community services for older and vulnerable adults.
%/ Linda J. Blessing
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text:
Tuesday, September 20, 2011
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But I guess I'll just quit while I'm ahead.
But I guess I'll just quit while I'm ahead.
18 comments:
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text:
Letters to the editor - Saturday (9-14-2013)
Rather than point fingers, let's find a use for books
People need to step back, take a deep breath and think. If there are usable books that the school system does not need, it is great to find that out.
Let's determine if there is a way to reuse them. That is better than recycling. Ask for public volunteers' ideas on how to pick the books up from the schools and distribute. One way I can think of is to have the schools accumulate books for a quarter and let volunteers pick them up for delivery to the public library. If the library does not want them, they could be taken across the street to the Farmers Market and given away. It would probably draw more people to the public library and the Farmers Market.
If that does not work, I am willing to volunteer to explore other methods of reusing the books, like involving churches. Some kids may not have any books at home. It is worth a try.
— John Leatherman
Stop the petty squabbling
I don't think that Rowan County can afford to wait out the terms of office of commissioners Jim Sides, Mike Caskey and Craig Pierce to halt the damage being done to its reputation and its ability to attract new business.
Would you locate your business in a county that thinks so little of its public education system and school administrators that they continue to require them to operate out of multiple substandard office buildings 20-plus years after merging the two systems? The squabble between the county commissioners and the school board/city of Salisbury continues to spiral out-of control. Meeting this critical need does not appear to be on the commissioners' agenda.
I applaud Jon Barber for his recent candidness on the central office issue. The city of Salisbury is located within Rowan County. Commissioners should represent the residents within the city limits of Salisbury just as equally as those without. It's not Rowan County against the city of Salisbury. It's not Rowan County against the school board. We're all in this together!
Our school administrators deserve a decent working environment. All of this pettiness detracts from the education of our youth. Can't a state law be enacted to allow for some type of recall election to replace commissioners who voters now feel are abusing the power entrusted to them? Let's give Jon Barber and Chad Mitchell some colleagues that are willing to reach a solution. In my opinion, the citizens of Rowan County should:
1. Lobby for a recall election and replace those three commissioners as soon as possible.
2. If that is not possible, voters should replace them as soon as their terms expire.
3. And if, while exercising option 1 or 2, any of them get reelected, then we collectively deserve to be the laughing stock of county governments across the state.
— Alvin Park
China Grove
Food drive a successs
In June, the community first heard that the need was great at Cooperative Christian Ministry. Our Summer Food Drive began and the community heard from clients and CCM staff about how low pantry shelves were getting and how high the need had reached. Now, in September, we can say, "Boy, did the community respond!"
Thanks to the generosity of local businesses (On The Run, Cannon Pharmacy, KS Image Solutions, F&M Bank, Centerview Hardware and the Independent Tribune) who sponsored the 2013 Summer Food Drive as collection points for non-perishable food, CCM collected 22,253 pounds of food! The community responded by bringing food to those drop off locations as well as the 10 pantries in the CCM pantry network and even to their churches as part of the 1,000 Can Challenge. Youngsters even collected cans in response to the Kids CAN Too! challenge. In addition to all the food we collected, the community also donated enough money for CCM to purchase about 25,000 pounds of food from Second Harvest Food Bank. That is an estimated 47,000 pounds of food that goes directly to help the hungry in our community.
The community helped CCM get through the summer months, when need is highest. Children are out of school, and parents who depend on school feeding programs to provide a hot meal or two for their young ones are left wondering where the next meal will come from. In August, CCM distributed 55,000 pounds of food through our pantries. The only months we didn't distribute more than 47,000 pounds of food this year have been February and March – when families receive tax checks to help offset food needs. To say the generosity of the community helped carry CCM through the summer is an understatement. Families continue to struggle, and the community continues to step up and help. CCM stands with the families of those provided food daily in saying, "Thank you," to our community.
— Joanie Reeder
Joanie Reeder is a development associate with Cooperative Christian Ministry in Concord.


text:
Few things in nature are as dramatic, and potentially dangerous, as ocean waves. The impact they have on our daily lives extends from shipping to the role they play in driving the global climate. From a theoretical viewpoint water waves pose rich challenges: solutions to the equations that describe fluid motion are elusive, and whether they even exist in the most general case is one of the hardest unanswered questions in mathematics.
It's official: the notorious Higgs boson has been discovered at the Large Hadron Collider at CERN. The Higgs is a subatomic particle whose existence was predicted by theoretical physics. Also termed the god particle, the Higgs boson is said to have given other particles their mass. But how did it do that? In this two-part article we explore the so-called Higgs mechanism, starting with the humble bar magnet and ending with a dramatic transformation of the early Universe.
In the first part of this article we explored Landau's theory of phase transitions in materials such as magnets. We now go on to see how this theory formed the basis of the Higgs mechanism, which postulates the existence of the mysterious Higgs boson and explains how the particles that make up our Universe came to have mass.
Infinity is a pain. Its paradoxes easily ensnare the unsuspecting reasoner. So over the centuries, mathematicians have carefully constructed bulwarks against its predations. But now cosmologists have developed theories that put them squarely outside the mathematicians' "green zone" of safety.
John Barrow gives us an overview, from Aristotle's ideas to Cantor's never-ending tower of mathematical infinities, and from shock waves to black holes.
Quantum mechanics and general relativity are incompatible — and this has led to a decades-long search for a theory of quantum gravity that could combine the two. But the particle physicist Richard Woodard thinks that the mismatch between the two could be nothing more than an illusion, created by the complicated maths techniques used in attempts to unite them.


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