California's budget problems do not discriminate between young and old. Caregivers for the elderly say recent cuts have already dramatically affected their ability to keep up with demand. Tara Siler of member station KQED has more from northern California.

TARA SILER: John Cottrell says Contra Costa County, north of San Francisco, used to have one of the state's best programs, protecting elderly adults from abuse and neglect. But recent state and county budget cuts have changed that. Cottrell heads the county's Aging and Adult Services program.

Mr. JOHN COTTRELL (Aging and Adult Services Program, Contra Costa County): The status of our department: fragile, yeah, very fragile right now. Very stressed.

SILER: In January, Cottrell laid off two-thirds of his staff who investigate abuse complaints of elderly and dependent adults. Wendy Beatty is one of the remaining six caseworkers. She says she used to spend much of her time on self-neglect cases, those involving people who aren't caring for themselves. But not anymore.

Ms. WENDY BEATTY (Caseworker, Aging and Adult Services Program): Only the most really egregious, where we might see that the individual is in imminent peril, are we going to be able to take right now.

SILER: What does Beatty consider egregious? She pulls out a file and hands over several large color photographs.

Ms. BEATTY: Both mom and daughter had major mental health issues, as is probably apparent in those pictures.

SILER: The images depict a classic case of hoarding, a home so jam-packed with boxes and refuse that it's nearly impassible inside. But the pictures also reveal something much worse: the mentally disabled adult daughter weighs less than 90 pounds, even though she's five-feet-seven.

Ms. BEATTY: She was malnourished and, as the pictures indicate, horrible foot ulcers. This young lady had not been out of the house for what family told me later was probably close to 10 years.

SILER: In this case, Beatty brought in a public health nurse and mental health worker from her department. The daughter received treatment, but Beatty says the specialist who assisted her had been laid off, and she is now expected to evaluate many cases by phone.

Ms. BEATTY: There had never been any outside intervention before we came along. So that was a case, in my mind, that there was no way that could've ever been solved with a phone call.

SILER: So what would happen in a case like this today?

Ms. BEATTY: I don't know.

SILER: What she does know is that Contra Costa County is now turning over virtually all its self-neglect cases to some other agency, often the police. The situation is so severe that the county grand jury recently concluded that Adult Protective Services no longer has the resources to carry out its legal mandate to investigate physical and financial abuse complaints.

Director John Cottrell disputes that, but concedes the agency's investigations are not as thorough as they used to be.

Meanwhile, he's bracing for the possibility of even fewer resources as the state scrambles the address the budget crisis.

Mr. COTTRELL: I've not been through this kind of a decline with nothing in sight for a bottom yet. We're in freefall. Now what? What are you going to cut now?

SILER: All this comes just as the state's elderly population and the incidents of elder abuse are exploding. Gary Passmore is president of the Congress of California Seniors.

Mr. GARY PASSMORE (President, Congress of California Seniors): My guess is that there are a lot of counties in California where they're really feeling overwhelmed and are experiencing great trepidation about what's going to happen in the next four to five years as the number of seniors, and therefore the number of abuse cases, grows enormously.

SILER: National studies estimate that just one in five elder abuse cases is reported. The complaints are already on the rise, especially those involving financial abuse. When asked if expects some vulnerable seniors will fall through the cracks, John Cottrell sighs and says probably more than some.

For NPR News, I'm Tara Siler.

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