By April Cyr

The Critical Role of Home Visits

A home visit can be a life-saving intervention. While respecting privacy is paramount, consider this scenario (shared with permission): Imagine a physician's office. An older woman brings a young adult, her dependent in their early twenties, for their first appointment. The older woman insists on accompanying them, stating she is their legal guardian and Power of Attorney. During the rushed pandemic environment, standard paperwork checks are overlooked. In the exam room, the young person remains silent, possibly nonverbal, while the older woman speaks for them. Despite concerning health issues, the mother dismisses them as stemming from a past car accident, overriding the physician's recommendations and treatments. The physician, hesitant to cause issues with a new patient, refrains from filing a 3200 Report (suspected abuse or neglect) and provides a prescription with a follow-up. They never hear from the patient again. The reality at home is stark: blocked fire exits due to clutter, numerous untrained shelter animals (mostly cats), a Π΄Π°Π²Π½ΠΎ expired and unopened first aid kit (2015), and a collection of painkillers and alcohol in the medicine cabinet. The five-acre gated property offers complete isolation. Rotting food fills the refrigerator. Five individuals reside there, all receiving Social Security Income, including a seemingly healthy teenage daughter for whom the mother is also the Rep Payee. The young person from the doctor's visit is nonverbal due to threats of violence if they speak out of turn and spends most of their time isolated in their room. Twelve live motion cameras monitor the property. Crucially, the doctor was unaware that the young man is blind and uses a walker due to past, untreated physical abuse from a decade prior. He suffers daily nosebleeds, leading to dizziness and near falls, and has no access to his benefit money. His potential death could go unnoticed for years. In four months, the cycle will likely repeat with a new doctor an hour and a half away.

The Power of Reporting

Had the physician filed a 3200 Report with Adult Protective Services (APS), a social worker would have conducted a home visit. While mandated reporting of suspected child abuse is common, reporting adult abuse is less so due to fear of repercussions and the intimidating reporting process. Without a home visit, this young man remains a virtual captive. Recognizing red flags, potentially indicating human trafficking, is crucial, and proper training could save lives.The Mandate of Adult Protective Services Established under Title XX of the Social Security Act in 1974, APS agencies exist in every US state to protect vulnerable adults (ages 18-59). Although specific policies vary, all states generally respond to complaints with a home visit within 24-48 business hours. While two-thirds of cases involve self-neglect in individuals living alone (where cooperation with a social worker is voluntary), investigations are initiated in cases of suspected abuse by others, often family or caregivers, to ensure the alleged victim's safety. Key Takeaway: "If you don't visit the client's home, you may never discover problems that have gone unvoiced." (https://apslibrary.oucpm.org/home-visits/)Addressing Issues of Capacity Home visits are essential to accurately assess an individual's capacity to care for themselves and manage daily life. Some individuals require significant assistance that can only be fully understood through observing their living environment. This information is vital for developing appropriate in-home service plans and ensuring their well-being.Counteracting Bias and Assumptions Even well-intentioned professionals hold unconscious biases and make assumptions about their clients. For example, assuming a client can easily incorporate a daily walk into their physical therapy without knowing about neighborhood safety issues, or assuming access to virtual schooling without verifying internet availability. The quality of care directly depends on the comprehensiveness of information, including the home environment. When assumptions are necessary, prioritize the least dangerous assumption. (https://cpresource.org/topic/school-education/what-least-dangerous-assumption)Understanding theΒ 

Environments of Homeless Populations

It's crucial to remember that even individuals experiencing homelessness have environments they navigate daily, even without stable housing. Unhoused individuals often have established patterns and locations, which are often kept secret due to vulnerability. Human service professionals can gain invaluable insight by meeting homeless clients in their own environments (both figuratively and literally). Observing their surroundings can reveal their capacity for living without stable housing. For instance, noticing a damaged tent needing repair, or understanding the challenges of accessing transportation or basic hygiene. This understanding allows for more effective and tailored support, such as providing new camping gear or connecting them with resources like bus passes or shower facilities.

References

National Adult Protective Services Association. (2017, May 16). History of Adult Protective Services | National Adult Protective Services Association. National Adult Protective Services Association | National Adult Protective Services Association. https://ndorc.com/about-napsa/history/history-of-adult-protective-services/ Bugaj, C. S. & Founding member of the Loudoun County Public Schools' Assistive Technology Team. (2021, December 7). What Is The Least Dangerous Assumption? Cerebral Palsy Foundation. https://cpresource.org/topic/school-education/what-least-dangerous-assumption**