Last year, Missouri's hotline for reports about abuse of elderly adults, as well as abuse of residents with disabilities, answered only half of its calls.
More than 17,000 callers heard the message, "All agents are busy, please call back," and the calls were disconnected.
Another 10,000 callers hung up or otherwise dropped the call before anyone answered.
Other calls went unanswered due to poor cell reception, staff error or an unknown reason.
Altogether, only about 50 percent of the 92,000 calls to the hotline last year were answered, according to a joint investigation by KBIA and The Columbia Missourian.
This year, it's even worse. Only about 39 percent of calls were answered from January to April.
"They're not pretty numbers," said Kathryn Sapp, policy unit bureau chief for the Division of Senior and Disability Services Adult Protective Services, under the Missouri Department of Health and Senior Services.
The hotline collects reports of abuse, neglect or exploitation of those 60 or older and people with disabilities ages 18-59. On the hotline's webpage are several serious examples.
One caller reported a 92-year-old living alone in a roach-infested home filled with debris and dog feces.
Another reported a man who had severely beaten his 70-year-old mother over the course of three hours.
Someone reported a woman for hitting her 38-year-old sister who had the cognitive abilities of a child after a brain injury. The woman said she knew how to hit her sister "without hurting her."
Eighteen full-time staff members and two part-time staff members are tasked with handling the calls.
The past decade has seen a 35 percent increase in reports of abuse or exploitation, according to data obtained through a public records request. The department added one hotline worker during this time.
The department attributes the increase in reports to an aging population and greater awareness of the Missouri Elder Abuse Hotline, based in Jefferson City.
Not all calls placed to the hotline are able to be kept on hold. The hotline can have four people waiting at a time. If the queue is maxed out, additional calls are dropped.
If callers made it to the queue, hold times averaged about eight and a half minutes during the first four months of this year, but some will wait longer than an hour to actually speak to someone. In February, a caller waited for an hour and 22 minutes.
"There's a ton of calls where people just hang up because of the length of time they're having to be on hold," Sapp said.
The Division of Senior and Disability Services didn't realize there were issues with the hotline until late 2018.
About a year ago, Jessica Bax took over as director for the Division of Senior and Disability Services. She said the department discovered problems after hearing complaints about long wait times and dropped calls. The data, however, didn't back up what she was hearing on the ground.
"There's been a lack of good data in the past, coupled with an increase in need that has led us to a point where we have to address a problem," Bax said.
The department gets information on their call handle rate from Unified Communications, run by Missouri's Office of Administration. Bax said data before 2018 didn't include dropped disconnected calls in the rate. This resulted in an inaccurate picture.
In the department's most recent budget request, which was submitted in October 2018, the call handle rate for fiscal year 2018 is listed as 98.8 percent. The call handle rate is projected to improve to 99 percent by next year. That's a stark contrast from the reality new calculations show.
Bax said her management team worked with Unified Communications to make sure they knew the true call handle rate by including dropped and disconnected calls in the data going forward.
"I think when you're looking at the projection in that budget book, you're looking at a projection before we had all of the information," Bax said. "And so you know, I would definitely be looking at that differently now."
System logistics
The hotline is open every day from 7 a.m. to midnight. Because there is no online submission form, callers are instructed to fax their reports after midnight.
The department doesn't track data on the number of calls that go unanswered when someone calls after the hotline closes.
The bureau has also told "mandated reporters," such as law enforcement or in-home care providers, to skip the hotline altogether if they cannot reach someone and fax their reports instead.
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Faxes and other methods of reporting have accounted for about 1,200 reports so far this year, but the call handle rate hasn't improved.
"A lot of the field staff are telling their friends, their partnerships out there, 'Call me directly if you can't get through -- here's my cell phone number,'" said Chrissie Sherman, an adult protective and community supervisor.
That's how Jennifer Shotwell was able to report a case of elder abuse. She's the chief executive officer at an Area Agency on Aging serving four counties in southwest Missouri.
She called the hotline just once after starting her job in December. She was on hold for more than 10 minutes, so she called again later and was put on hold for at least 10 minutes.
Shotwell hung up and called someone she knew at the Department of Health and Senior Services who took her report. The department responded quickly once she was able to get through, she said.
"That is my big fear is we're losing folks because they couldn't get through [to the hotline]," Sapp said. "They don't call back. And so that means someone's out there vulnerable."
That's exactly what Samantha Ferguson Knight is concerned about. She's the director of senior programming at Kingdom House in St. Louis.
"Have you ever been on hold with a bill collector or someone that's trying to take your time, and you call and you wait, and you wait and wait?" Ferguson Knight said. "Most people generally give up."
Ferguson Knight said she's had issues calling the hotline. When she called the hotline on April 24, her call was dropped. Over the course of a day and a half, she called back 11 times and was on hold for a total of two hours before she was able to make a report.
Sapp said she realizes a faxed form might not be accessible to a victim of abuse. The department wants an online submission form but lacks the funding. The department is also applying for a grant and trying to streamline the current reporting process.
"We've kind of had to get scrappy, you know -- part of the deal is when you don't have any resources, you have to be kind of creative," Sapp said.
Critical needs
The department is first addressing inefficiencies in the hotline before requesting funding for additional workers. Bax said the department is looking at how other states run their hotlines.
The department is also trying to decrease the length of time a hotline worker spends writing up a report of abuse or neglect to allow workers to spend more time answering calls.
Bax said the department has begun to allow hotline workers to telecommute during "undesirable shifts," which has decreased the staff turnover.
Not everyone has experienced problems with the hotline. James Stowe, the director of aging and adult services at the Mid-America Regional Council based in Kansas City, said his agency calls the hotline about once a week.
"From what I'm hearing from the staff, we have not experienced inordinate wait times for our reports that we're making," Stowe said.
Chad Jordon is the vice president of the Missouri Coalition for Quality Care, a nonprofit advocacy group for older Missourians who receive long-term care.
Jordon said the hotline needs to be staffed 24 hours a day.
"That is critical, and it's a travesty. When a person calls, they need to be able to report it," Jordon said. "They need to be able to talk to someone who could help them."
This year's state budget doesn't include an increase in funding to staff the hotline. Bax said there may be a future request for additional funding if the department cannot address the hotline issues by improving efficiencies.
"This is something we need to address this summer or the fall to get the data together to give it to someone on the budget committee," said Missouri House Rep. Rudy Veit, R-Wardsville. "It seems to me like if it's just a pure number of employees or number of people to answer the calls, we just need to get more people there."
Veit is on the Special Committee on Aging created this legislative session, but this is the first time he's heard about an issue with the hotline.
Rep. Lynn Morris, R-Nixa, chairs the committee and also said he was unaware of the problem. He said the numbers are alarming.
"They need to figure out how to answer the phone," Morris said. "When people call, these are taxpayers. The older taxpayers have probably paid more taxes in their lifetime than someone else says, and my feeling is you better figure out how to answer the phone."
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