Elder Justice
Stronger Federal Leadership Could Enhance National Response to Elder Abuse [Reissued on March 22, 2011] Gao ID: GAO-11-208 March 2, 2011Each day, news reports cite instances of older adults across the United States being abused, denied needed care, or financially exploited, often by those they depend on. This report contains information on (1) existing estimates of the extent of elder abuse and their quality, (2) factors associated with elder abuse and its impact on victims, (3) characteristics and challenges of state Adult Protective Services (APS) responsible for addressing elder abuse, and (4) federal support and leadership in this area. To obtain this information, GAO reviewed relevant research; visited six states and surveyed state APS programs; analyzed budgetary and other federal documents; reviewed federal laws and regulations; and interviewed federal officials, researchers, and elder abuse experts.
The most recent study of the extent of elder abuse estimated that 14.1 percent of noninstitutionalized older adults had experienced physical, psychological, or sexual abuse; neglect; or financial exploitation in the past year. This study and three other key studies GAO identified likely underestimate the full extent of elder abuse, however. Most did not ask about all types of abuse or include all types of older adults living in the community, such as those with cognitive impairments. In addition, studies in this area cannot be used to track changes in extent over time because they have not measured elder abuse consistently. Based on existing research, various factors appear to place older adults at greater risk of abuse. Physical and cognitive impairments, mental problems, and low social support among victims have been associated with an increased likelihood of elder abuse. Elder abuse has also been associated with negative effects on victims' health and longevity. Although state APS programs vary in their organization and eligibility criteria, they face many of the same challenges. According to program officials, elder abuse caseloads are growing nationwide and cases are increasingly complex and difficult to resolve. However, according to GAO's survey, APS program resources are not keeping pace with these changes. As a result, program officials noted that it is difficult to maintain adequate staffing levels and training. In addition, states indicated they have limited access to information on interventions and practices on how to resolve elder abuse cases, and may struggle to respond to abuse cases appropriately. Many APS programs also face challenges in collecting, maintaining, and reporting statewide case-level administrative data, thereby hampering their ability to track outcomes and assess the effectiveness of services provided. Federal elder justice activities have addressed some APS challenges, but leadership in this area is lacking. Seven agencies within the Departments of Health and Human Services (HHS) and Justice devoted a total of $11.9 million in grants for elder justice activities in fiscal year 2009. These activities have promoted collaboration among APS and its partners, such as law enforcement, but have not offered APS the support it says it needs for resolving elder abuse cases and standardizing the information it reports. Although the Older Americans Act of 1965 has called attention to the importance of federal leadership in the elder justice area, no national policy priorities currently exist. The Administration on Aging in HHS is charged with providing such leadership, but its efforts to do so have been limited. The Elder Justice Act of 2009 authorizes grants to states for their APS programs and provides a vehicle for establishing and implementing national priorities in this area, but does not address national elder abuse incidence studies. The Secretary of HHS should determine the feasibility of providing APS-dedicated guidance, and, in coordination with the Attorney General, facilitate the development and implementation of a nationwide APS data system. Also, Congress should consider requiring HHS to conduct a periodic study to estimate elder abuse's extent. HHS indicated that it will review options for implementing GAO's recommendations.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Kay E. Brown Team: Government Accountability Office: Education, Workforce, and Income Security Phone: (202) 512-3674GAO-11-208, Elder Justice: Stronger Federal Leadership Could Enhance National Response to Elder Abuse [Reissued on March 22, 2011]
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United States Government Accountability Office:
GAO:
Report to the Chairman, Special Committee on Aging, U.S. Senate:
March 2011:
Elder Justice:
Stronger Federal Leadership Could Enhance National Response to Elder
Abuse:
[Note: On March 21, 2011, this report was revised to correct
typographical and formatting errors. In Table 3 on page 17, the number of
reports received is now 357,000 and the number of states responding is
now 31. On page 18, line 25, the number of states is now 38. In appendix V,
a ’yes“ has been added in the column ’Can the older adult qualify based on
age alone?“ for Oregon. In appendix VI, the entry for Missouri was in error
and has been deleted. In appendix VIII, the entry for Tennessee under ’Older
Americans Act formula grants“ and for Wisconsin under ’Other nonfederal
funds“ were in error and have been deleted. The totals for these two columns
are now $1,715,912 and $14,041,750, respectively. In appendices V and VIII,
shading errors have been corrected. These changes have no effect on the
report‘s findings, conclusions, or recommendations.
GAO-11-208:
GAO Highlights:
Highlights of GAO-11-208, a report to the Chairman, Senate Special
Committee on Aging, U.S. Senate.
Why GAO Did This Study:
Each day, news reports cite instances of older adults across the
United States being abused, denied needed care, or financially
exploited, often by those they depend on. This report contains
information on (1) existing estimates of the extent of elder abuse and
their quality, (2) factors associated with elder abuse and its impact
on victims, (3) characteristics and challenges of state Adult
Protective Services (APS) responsible for addressing elder abuse, and
(4) federal support and leadership in this area.
To obtain this information, GAO reviewed relevant research; visited
six states and surveyed state APS programs; analyzed budgetary and
other federal documents; reviewed federal laws and regulations; and
interviewed federal officials, researchers, and elder abuse experts.
What GAO Found:
The most recent study of the extent of elder abuse estimated that 14.1
percent of noninstitutionalized older adults had experienced physical,
psychological, or sexual abuse; neglect; or financial exploitation in
the past year. This study and three other key studies GAO identified
likely underestimate the full extent of elder abuse, however. Most did
not ask about all types of abuse or include all types of older adults
living in the community, such as those with cognitive impairments. In
addition, studies in this area cannot be used to track changes in
extent over time because they have not measured elder abuse
consistently.
Based on existing research, various factors appear to place older
adults at greater risk of abuse. Physical and cognitive impairments,
mental problems, and low social support among victims have been
associated with an increased likelihood of elder abuse. Elder abuse
has also been associated with negative effects on victims‘ health and
longevity.
Although state APS programs vary in their organization and eligibility
criteria, they face many of the same challenges. According to program
officials, elder abuse caseloads are growing nationwide and cases are
increasingly complex and difficult to resolve. However, according to
GAO‘s survey, APS program resources are not keeping pace with these
changes. As a result, program officials noted that it is difficult to
maintain adequate staffing levels and training. In addition, states
indicated they have limited access to information on interventions and
practices on how to resolve elder abuse cases, and may struggle to
respond to abuse cases appropriately. Many APS programs also face
challenges in collecting, maintaining, and reporting statewide case-
level administrative data, thereby hampering their ability to track
outcomes and assess the effectiveness of services provided.
Federal elder justice activities have addressed some APS challenges,
but leadership in this area is lacking. Seven agencies within the
Departments of Health and Human Services (HHS) and Justice devoted a
total of $11.9 million in grants for elder justice activities in
fiscal year 2009. These activities have promoted collaboration among
APS and its partners, such as law enforcement, but have not offered
APS the support it says it needs for resolving elder abuse cases and
standardizing the information it reports. Although the Older Americans
Act of 1965 has called attention to the importance of federal
leadership in the elder justice area, no national policy priorities
currently exist. The Administration on Aging in HHS is charged with
providing such leadership, but its efforts to do so have been limited.
The Elder Justice Act of 2009 authorizes grants to states for their
APS programs and provides a vehicle for establishing and implementing
national priorities in this area, but does not address national elder
abuse incidence studies.
What GAO Recommends:
The Secretary of HHS should determine the feasibility of providing APS-
dedicated guidance, and, in coordination with the Attorney General,
facilitate the development and implementation of a nationwide APS data
system. Also, Congress should consider requiring HHS to conduct a
periodic study to estimate elder abuse‘s extent. HHS indicated that it
will review options for implementing GAO‘s recommendations.
View [hyperlink, http://www.gao.gov/products/GAO-11-208] or key
components. For more information, contact Kay E. Brown at (202) 512-
7215 or brownke@gao.gov. Survey questions and responses are presented
in GAO-11-129SP, an electronic supplement.
[End of section]
Contents:
Letter:
Background:
Existing Research Underestimates, and Cannot Be Used to Track Trends
in, the Full Extent of Elder Abuse:
Elder Abuse Is Associated with a Number of Risk Factors and Has a
Significant Impact on Its Victims:
Nationwide, State APS Programs Face Significant Challenges:
Federal Elder Justice Activities Have Provided Some Support to APS,
but Federal Leadership Is Lacking:
Conclusions:
Recommendations for Executive Action:
Matter for Congressional Consideration:
Agency Comments:
Appendix I: Growth in Percentage of U.S. Elderly Population, 1900-2050:
Appendix II: Scope and Methodology:
Appendix III: Mandatory Reporters to APS of Elder Abuse by State:
Appendix IV: APS Organizational Structure and Location by State:
Appendix V: Selected APS Eligibility Criteria in Cases of Alleged
Elder Abuse by State:
Appendix VI: Estimated Elder Abuse Reports to APS, and APS
Investigations and Substantiations in State Fiscal Year 2009:
Appendix VII: Sources of Funding for APS Operations in 28 States in
State Fiscal Year 2009:
Appendix VIII: APS Program Budgets by State in State Fiscal Year 2009:
Appendix IX: Comments from the Department of Health and Human Services:
Appendix X: GAO Contact and Staff Acknowledgments:
Selected Bibliography:
Related GAO Products:
Tables:
Table 1: Types of Elder Abuse:
Table 2: Studies of Extent of Elder Abuse:
Table 3: APS Estimates of Reports Received, Investigations, and
Substantiations in State Fiscal Year 2009:
Table 4: Federal Elder Justice Activities, Fiscal Years 2005-2009:
Table 5: History of Federal Efforts to Identify Elder Abuse Research
Priorities, Fiscal Years 2000-2010:
Figures:
Figure 1: APS Process for Addressing Alleged Elder Abuse:
Figure 2: Federal Funding Agencies Spent on Elder Justice Activities
by Department and Agency, Fiscal Year 2009:
Abbreviations:
AoA: Administration on Aging:
APS: Adult Protective Services:
CDC: Centers for Disease Control and Prevention:
EJA: Elder Justice Act:
Justice: Department of Justice:
HHS: Department of Health and Human Services:
NCEA: National Center on Elder Abuse:
OAA: Older Americans Act:
SSBG: Social Services Block Grant:
View GAO-11-208 key component:
Elder Justice: Survey of Adult Protective Services Program
Administrators (GAO-11-129SP, March 2011), an E-supplement to GAO-11-
208.
[End of section]
United States Government Accountability Office:
Washington, DC 20548:
March 2, 2011:
The Honorable Herb Kohl:
Chairman:
Special Committee on Aging:
United States Senate:
Dear Mr. Chairman:
Each day across this country, news stories chronicle the plight of
vulnerable older Americans who are denied food and water, left to live
under deplorable conditions, or physically and psychologically abused,
often by family members or others they trust and depend upon. Neglect
and abuse can often go hand in hand with financial exploitation, which
can rob older adults of the life savings and property they count on to
support them in old age.[Footnote 1] In addition to the physical,
psychological, and economic harm elder abuse inflicts on older adults,
it imposes an economic burden on all Americans. Victims of elder abuse
and neglect can incur higher health care expenses, further straining
already overtaxed Medicare and Medicaid resources and increasing the
demand for a range of supportive services, and older adults left
without the means to live independently may have to rely on publicly
supported long-term care placements. As the American population ages,
the extent of abuse will likely grow. According to U.S. Census Bureau
data, persons 65 years of age and older, who represented about 13
percent of the population in 2008, will make up nearly 20 percent by
2030.[Footnote 2]
In the United States, the Adult Protective Services (APS) program in
each state is generally responsible for identifying, investigating,
resolving, and preventing abuse of older adults.[Footnote 3] Because
APS clients have the right to self-determination, APS caseworkers may
encounter individuals who appear to need basic protections such as
separation from their alleged abuser, but who refuse offers of
assistance and protection.[Footnote 4] In addition, given state
governments' current fiscal crises, there is concern that potential
cuts in funding for APS will threaten these programs' ability to
effectively respond to the needs of a rapidly growing older adult
population and the increased incidence of elder abuse that can come
with it. In light of these concerns, and given the role of the federal
government under the Older Americans Act of 1965 (OAA)[Footnote 5] and
the Elder Justice Act of 2009 (EJA)[Footnote 6] to lead national elder
justice activities and thereby support efforts to protect older adults
from abuse,[Footnote 7] this report contains information on (1)
existing estimates of the extent of elder abuse and their quality; (2)
factors associated with elder abuse and its impact on its victims; (3)
state APS programs' responsibilities, organization, reporting and
eligibility requirements, and challenges; and (4) federal funding,
activities, and leadership in this area.
To address the first two objectives, we relied primarily on a
literature review of published research on the nature and extent of
elder abuse, drawing from various social science research databases
and studies cited by elder abuse experts, and assessing the quality of
the research identified.[Footnote 8] To determine the
responsibilities, organization, reporting and eligibility
requirements, and challenges of state APS programs, we conducted a
survey of APS programs in all 50 states and the District of Columbia.
All 50 states responded to the survey, and the District of Columbia
did not. Survey questions and responses are presented in GAO-11-129SP,
an electronic supplement to this report. We did not independently
verify the information pertaining to state laws that was reported by
survey respondents.[Footnote 9] We also conducted in-depth site visits
of APS programs in California, Florida, Georgia, Maryland, Texas, and
Virginia, and interviewed APS officials in the District of Columbia,
Maine, and Pennsylvania. We selected these states to achieve variation
in location and administrative structure of APS programs, and in the
size of their older adult population. To identify federal funding
activities and leadership in this area, we interviewed federal
officials from the Departments of Health and Human Services (HHS) and
Justice (Justice), analyzed federal budgetary and other documents, and
reviewed relevant federal laws and regulations. We focused on federal
efforts for fiscal years 2005 through 2009. Interviews with elder
abuse researchers, other experts, and representatives from
organizations with an interest in elder abuse issues also provided
valuable information for this study. This review focused on abuse of
older adults living in the community, as opposed to in long-term care
facilities or other institutions.
We conducted this performance audit from November 2009 through
February 2011 in accordance with generally accepted government
auditing standards. These standards require that we plan and perform
the audit to obtain sufficient, appropriate evidence to provide a
reasonable basis for our findings and conclusions based on our audit
objectives. We believe that the evidence obtained provides a
reasonable basis for our findings and conclusions based on our audit
objectives.
Background:
Elder abuse is a complex phenomenon. Table 1 describes the types of
elder abuse, according to the National Center on Elder Abuse (NCEA).
[Footnote 10]
Table 1: Types of Elder Abuse:
Type[A]: Physical abuse;
Description: Use of physical force against an older adult that may
result in bodily injury, physical pain, or impairment;
Examples: Striking with an object, hitting, pushing, shoving, etc.
Type[A]: Sexual abuse;
Description: Nonconsensual sexual contact of any kind with an older
adult;
Examples: Unwanted touching, rape, sodomy, coerced nudity, etc.
Type[A]: Psychological abuse[B];
Description: Infliction of anguish, pain, or distress on an older
adult through verbal or nonverbal acts;
Examples: Verbal assaults, insults, threats, intimidation,
humiliation, and harassment.
Type[A]: Financial exploitation;
Description: Illegal or improper use of an older adult's funds,
property, or assets;
Examples: Cashing an older adult's checks without authorization.
Forging an older adult's signature. Misusing or stealing an older
adult's money or possessions.
Type[A]: Neglect;
Description: Refusal or failure to fulfill any part of a person's
obligation or duties to an older adult;
Examples: Refusing or failing to provide an older adult with such
necessities as food, water, clothing, shelter, personal hygiene,
medicine, comfort, personal safety, and other essentials.
Source: National Center on Elder Abuse.
[A] Federal and state law may define these terms differently.
[B] Psychological abuse can also be referred to as verbal or emotional
abuse.
[End of table]
The NCEA also includes self-neglect--behaviors of an older adult that
threaten his or her safety--as a form of elder abuse. However, there
is disagreement as to whether self-neglect should be considered a form
of abuse because it does not involve a perpetrator, per se. Almost all
APS programs respond to allegations of self-neglect, and this
response, which can include court determinations of capacity and
designation of a caregiver, can require significant public resources.
More than one type of abuse can occur at the same time. For example,
financial exploitation may occur in conjunction with neglect or
psychological abuse. In addition, abuse can occur repeatedly over time
and can involve a relationship of trust between the victim and the
perpetrator.[Footnote 11] Thus, the perpetrator may be a family
member, a caregiver, or a guardian appointed by a judge. This
relationship between the victim and the perpetrator can make
identifying, investigating, and resolving cases of elder abuse a
challenging endeavor.
In some states, there are criminal penalties for abusive behavior
toward an older adult. In others, "elder abuse," in and of itself, is
not considered a crime, and abusive behavior toward an older adult can
be prosecuted only if it fits within the definition of another crime
such as assault, theft, or fraud. Some of these states provide
enhanced penalties for certain crimes if they are committed against
older adults.
The responsibility for responding to alleged and resolving
substantiated elder abuse rests with each state's APS program, and
most of these programs respond to and resolve alleged abuse of at-risk
adults, as well. APS programs address elder abuse in community
settings in all states and, in some states, also address elder abuse
in long-term care facility settings. State survey and certification
agencies investigate abuse in nursing facilities which participate in
Medicaid and/or Medicare.[Footnote 12] In many states, licensing
agencies investigate abuse in state-licensed long-term care
facilities, which typically include nursing homes, assisted-living
facilities, and board and care homes. In addition, state Long-Term
Care Ombudsman Programs resolve complaints and advocate for residents
of nursing homes, assisted-living facilities, and board and care homes
related to, but not limited to, abuse situations.[Footnote 13]
Two federal statutes establish the federal government's role and
responsibilities with regard to elder abuse, in general--the OAA
[Footnote 14] and the EJA.[Footnote 15] The OAA created the
Administration on Aging (AoA) within HHS and requires it to administer
formula grants to state agencies on aging for elder abuse awareness
and prevention activities.[Footnote 16] The OAA also requires AoA to
develop objectives, priorities, policy, and a long-term plan for:
* facilitating the development, implementation, and continuous
improvement of a coordinated, multidisciplinary elder justice system
in the United States;
* promoting collaborative efforts and diminishing duplicative efforts
in the development and carrying out of elder justice programs at the
federal, state, and local levels;
* establishing an information clearinghouse to collect, maintain, and
disseminate information concerning best practices and resources for
training, technical assistance, and other activities to assist states
and communities to carry out evidence-based programs to prevent and
address elder abuse, neglect, and exploitation;
* working with states, Justice, and other federal agencies to annually
collect, maintain, and disseminate data on elder abuse, neglect, and
exploitation, to the extent practicable;
* establishing federal guidelines and disseminating best practices for
uniform data collection and reporting by states;
* conducting research on elder abuse, neglect, and exploitation; and:
* carrying out a study to determine the extent of elder abuse,
neglect, and exploitation in all settings.[Footnote 17]
The EJA contains provisions that apply to APS as well as elder
justice, in general. It authorizes funding for:
* Annual formula grants specifically to state APS programs under Title
XX of the Social Security Act and requires states to report the number
of elders served by these grants;[Footnote 18]
* HHS to:
- annually collect and disseminate data regarding elder abuse,
neglect, and exploitation of elders in coordination with Justice;
[Footnote 19]
- develop and disseminate information on best practices and provide
training for carrying out adult protective services;[Footnote 20]
- conduct research related to the provision of adult protective
services;[Footnote 21]
- provide technical assistance to states and others that provide or
fund the provision of adult protective services;[Footnote 22] and:
- establish 10 elder abuse, neglect, and exploitation forensic
centers, in consultation with Justice, that would (1) conduct research
to describe and disseminate information on forensic markers for elder
abuse, neglect, or exploitation, and methodologies for determining
when and how health care, emergency, social and protective, and legal
service providers should intervene and when these cases should be
reported to law enforcement; (2) develop forensic expertise regarding
elder abuse, neglect, and exploitation; and (3) use the data these
centers make available, in coordination with Justice, to develop the
capacity of geriatric health care professionals and law enforcement
authorities to collect forensic evidence, including evidence needed to
determine if elder abuse, neglect, or exploitation has occurred.
[Footnote 23]
* Grants to state and local governments for demonstration projects
that test methods and training to detect or prevent elder abuse or
financial exploitation;[Footnote 24]
* An Elder Justice Coordinating Council and an Advisory Board on Elder
Abuse, Neglect, and Exploitation to develop priorities for the elder
justice field, coordinate federal activities, and provide
recommendations to Congress.[Footnote 25]
Justice is also required to provide assistance to victims of abuse in
general under the Victims of Crime Act of 1984[Footnote 26] and of
domestic violence under the Violence Against Women Act.[Footnote 27]
These requirements are not specific to older adults, however.
Existing Research Underestimates, and Cannot Be Used to Track Trends
in, the Full Extent of Elder Abuse:
In our review of relevant literature, we identified four studies over
the past two decades that attempted to provide insight into the extent
of elder abuse nationally (see Table 2).[Footnote 28]
Table 2: Studies of Extent of Elder Abuse:
Title/Author: "The National Elder Mistreatment Study," by Ron Acierno
et al[A];
Date: 2009;
Data collection method: Phone interviews;
Sampling method: Sample of just under 6,000 community-dwelling adults
ages 60 and older, identified through national random-digit dialing;
Results: An estimated 14.1 percent of adults age 60 and older
experienced physical, psychological, or sexual abuse; potential
neglect; or financial exploitation in the past year[B];
Limitations: Did not include self-neglect;
Did not include highly cognitively impaired individuals.
Title/Author: "Elder Mistreatment in the United States: Prevalence
Estimates from a National Study," by Edward O. Laumann et al;
Date: 2008;
Data collection method: In-person interviews;
Sampling method: Random subsample of 3,005 community-dwelling older
adults nationwide ages 57 to 85;
Results: An estimated 9 percent of adults ages 57 to 85 experienced
verbal abuse, 3.5 percent financial abuse, and 0.2 percent physical
abuse over the past year;
Limitations: Did not include sexual abuse, neglect, or self-neglect;
Generally did not include highly cognitively impaired individuals.
Title/Author: "The National Elder Abuse Incidence Study,";
by the National Center on Elder Abuse et al;
Date: 1998;
Data collection method: Used 1,100 trained individuals--also called
sentinels--from a variety of community agencies having frequent
contact with the elderly to gather data on elder abuse;
Sampling method: Sample of sentinels from 248 community agencies in 20
counties in 15 states;
Results: An estimated 1.25 percent of adults ages 60 and older
experienced abuse in 1996;
Limitations: Because there is no single organization that all older
adults come into contact with, the estimate may not include isolated
individuals and those who had little contact with community
organizations.
Title/Author: "The Prevalence of Elder Abuse: A Random Sample Survey,"
by Karl Pillemer and David Finkelhor;
Date: 1988;
Data collection method: In-person and phone interviews;
Sampling method: Random sample of 2,020 community-dwelling adults ages
65 and older in the Boston metropolitan area;
Results: An estimated 3.2 percent of adults ages 65 and older in the
Boston metropolitan area experienced physical abuse since age 65 or
psychological abuse or neglect in the past year;
Limitations: Did not include financial exploitation or self-neglect;
Used different time frames to measure different types of abuse;
Results limited to Boston metropolitan area.
Source: GAO analysis of various studies.
[A] The results of this study were also published in Ron Acierno et
al.; "Prevalence and Correlates of Emotional, Physical, Sexual, and
Financial Abuse and Potential Neglect in the United States: The
National Elder Mistreatment Study," American Journal of Public Health,
vol. 100, no. 2 (February, 2010).
[B] Although this article reports a combined one-year prevalence
figure of 11.4 percent, the estimate we provide also takes into
account the prevalence of financial exploitation found by this study.
[End of table]
These studies have made important contributions to what is known about
the extent of elder abuse. For example, elder abuse experts stated
that the two most recent studies have helped demonstrate the
feasibility of conducting nationwide studies on the extent of elder
abuse. However, they do not provide a full estimate of its extent,
either because they did not take into account all types of abuse or
excluded cognitively impaired older adults from their sample, although
these older adults may make up a significant portion of the elder
population.[Footnote 29] Moreover, because the research methods used
by these studies varied, elder abuse has not been measured
consistently. As a result, these estimates cannot be used to track
trends in the extent of elder abuse.
Elder Abuse Is Associated with a Number of Risk Factors and Has a
Significant Impact on Its Victims:
Elder Abuse Has Been Associated with a Number of Risk Factors:
A number of studies have associated physical impairment, mental health
problems, cognitive impairment, and inadequate social support with
elder abuse. These factors can vary by type of abuse and can occur in
combination. In addition, some of these factors may characterize both
the victim and the perpetrator.
Physical Impairment:
A number of studies of noninstitutionalized older adults suggest that
elder abuse is associated with physical impairment, which is not
uncommon in this population. Physically impaired older adults may be
less able to defend themselves from their abuser. For example, a 1997
study of older adults in Connecticut found that inability to perform
activities of daily living, such as bathing or dressing themselves,
left them more vulnerable to elder abuse.[Footnote 30] In addition, a
1988 study of older adults in the Boston metropolitan area found that
respondents in poorer health were more likely to be abused.[Footnote
31] A 2010 study found that those who reported having difficulty
completing at least one instrumental activity of daily living, such as
housework or using the phone, were at greater risk of financial
exploitation.[Footnote 32],[Footnote 33] Physically impaired older
adults may be at increased risk of abuse because they are more
dependent on potential abusers. A 2005 study of caregiver and
recipient pairs found that when spouses were the caregivers, they were
more likely to display abusive behavior when the recipients had
greater need for care.[Footnote 34]
Mental Health Problems:
Elder abuse has also been associated with mental health problems. For
example, a study in 2000 found that victims of elder abuse who had
been referred to a Houston-area hospital had higher levels of
depression than older patients referred for other reasons.[Footnote
35] A 2010 study of older adults in Pennsylvania found that risk of
clinical depression among these adults was a consistent predictor of
financial and psychological abuse.[Footnote 36] This may be because
depression may make older adults less likely to ask for help, and
therefore more vulnerable to elder abuse. Research has also linked
elder abuse to depression among perpetrators. A 2005 study of
caregivers of older adults in Florida with Alzheimer's disease
associated depression among caregivers with increased risk of
psychological abuse of the older adult they were caring for.[Footnote
37] In addition, another 2010 study found that perpetrators of
physical, emotional, and sexual abuse of adults age 60 and above were
more likely to have mental health problems than the general
population.[Footnote 38] The association between alcohol abuse and
abusive behavior is well known. A 2005 study of elder abuse victims in
Virginia found that alcohol abuse also was more likely to be found
among self-neglecting older adults than among victims of other types
of elder abuse.[Footnote 39] The 2010 study of perpetrators mentioned
above also found that perpetrators were more likely to be substance
abusers than the general population.[Footnote 40]
Cognitive Impairment:
Cognitively impaired older adults may be most at risk of abuse because
they are unable to defend themselves from or even recognize the abuse
or neglect. For example, a 2009 study of older adults in the Chicago
area found that self-neglect was associated with a poorer ability to
remember past events in one's life and to recognize similarities and
differences among objects, along with lower levels of overall
cognitive function.[Footnote 41] Similarly, a 1997 study of
noninstitutionalized older adults in Connecticut found that as
cognitive function declined, the likelihood of abuse increased.
[Footnote 42] Cognitive impairment related to dementia may also make
older adults more vulnerable to abuse. For example, the 2000 study of
patients at a Houston-area hospital mentioned above found that
dementia, as well as depression, was associated with elder abuse.
[Footnote 43] In addition, a 2010 study of self-selected caregiver-
care recipient pairs in California found that 61 of the 129 study
participants with dementia had been mistreated by their caregivers.
[Footnote 44],[Footnote 45] Dementia may cause increased hostility or
aggressiveness, which can increase caregiver stress and possibly
result in a more aggressive response by caregivers.
Lack of Adequate Social Support:
Research suggests that older adults who lack adequate social support--
ongoing connections with others that make a person feel cared for,
valued, and part of a network--may be at greater risk of abuse. For
example, a 2010 study found that low social support among those over
60 years of age was a predictor of most forms of abuse, and that high
social support could help prevent abuse.[Footnote 46] According to one
researcher, strong social ties make abuse less likely, in part,
because there are more opportunities to defuse tensions between an
older adult and a potential perpetrator or to monitor their
interaction. For example, according to a 2006 study that compared
older adults who had been victims of self-neglect with other older
adults, the self-neglecters had less contact with children and
siblings, visited less frequently with friends and neighbors, and
participated less in religious activities.[Footnote 47] In addition, a
review of 21 studies by the National Center on Elder Abuse in 2005
found that elder abuse perpetrators often also lack social support and
are likely to have problems with relationships.[Footnote 48] A 2009
study also found that in about half of all of the cases in which the
perpetrators of elder abuse were known to the victim, victims reported
that their abusers were socially isolated.[Footnote 49]
Elder Abuse Has Been Associated with Poorer Health and a Shorter
Lifespan:
Studies suggest that elder abuse may affect victims' health and
longevity. For example, a 2006 study found that older women in the
Midwest who were psychologically abused once, repeatedly, or in
conjunction with other forms of abuse,[Footnote 50] also reported
higher rates of certain health problems than older women who had not
been abused.[Footnote 51] Two studies have linked elder abuse with a
shorter lifespan. A 1998 longitudinal study comparing abused and
nonabused community-dwelling older adults in Connecticut found that
only 9 percent of those abused at some point between 1982 and 1992
were still alive in 1995,[Footnote 52] compared to 40 percent of those
who had not been investigated for abuse during that same period.
[Footnote 53] In a 2009 study of community-dwelling older adults in
Chicago, those who had been reported to social services agencies for
abuse faced an increased risk of mortality compared to those who had
not been reported for abuse.[Footnote 54],[Footnote 55]
Nationwide, State APS Programs Face Significant Challenges:
APS Programs have Similar Responsibilities, but Reporting
Requirements, Organization, and Eligibility Criteria Vary:
The primary responsibilities of state APS programs are to receive
reports of alleged elder abuse, investigate these allegations,
determine whether or not the alleged abuse should be substantiated,
and arrange for services to ensure victims' well-being. All APS
programs employ a multistep process for addressing elder abuse. Figure
1 presents the typical APS process for addressing alleged elder abuse,
but this process can vary somewhat from state to state.
Figure 1: APS Process for Addressing Alleged Elder Abuse:
[Refer to PDF for image: illustration]
1) APS receives a report of suspected abuse of an older adult.
2) APS staff screen the case to determine whether it meets eligibility
criteria:
Case not eligible for APS: Case may be referred for other services as
needed.
APS eligibility criteria:
* Age of the victim;
* Type of alleged elder abuse;
* The victim‘s vulnerability or dependence;
* The victim‘s relationship with the perpetrator.
Case is eligible for APS:
3) Case is assigned to an APS caseworker for investigation.
4) Caseworker makes contact with older adult to assess any immediate
risk, investigate the abuse allegations, and determine if abuse is
substantiated. Law enforcement may be asked to assist with the
investigation.
5) APS may provide or arrange for a variety of services intended to
ensure the older adult‘s immediate safety and well-being.
Services may include:
* Medical care;
* Emergency placement;
* Food delivery;
* Attendant care.
Substantiated cases involving criminal activity are referred to
prosecutor.
6) Once the investigation is complete, services may be extended for a
limited time to ensure the victim‘s safety and well-being.
Source: GAO analysis of survey results and interviews from site visits.
[End of figure]
Laws concerning who is legally required to report suspected elder
abuse incidents to APS differ by state. Our survey results show that
14 states require everyone to report suspected elder abuse, while 32
states require only certain professionals to report it. Four states
indicated in the survey that they had no mandatory reporting
requirements related to elder abuse.[Footnote 56]
With regard to the organization of APS in each state, our survey
results show that APS programs in 32 states were state-administered;
that is, the state funded and directly managed the program statewide.
[Footnote 57] APS programs in 16 states were state-supervised. In
these states, the state provided funding to counties, other
governmental, or nongovernmental entities to manage APS.[Footnote 58]
In states in which APS was state-administered, APS employees were
typically employed by the state, while in state-supervised states APS
employees generally worked for the counties, other governmental, or
nongovernmental entities that provide services. The state agencies
that oversee APS programs can also differ. In 22 states, APS programs
were part of the state agency on aging, which plans, develops, and
coordinates a wide array of home-and community-based services under
the OAA. In states where APS was not located within the state agency
on aging, APS was most commonly housed within the state department of
health and human services.[Footnote 59]
Eligibility criteria for receiving APS services are determined by
state law, and can therefore vary from state to state. States reported
that their eligibility criteria can include the:
* age of the victim,
* type of alleged elder abuse,
* victim's vulnerability or dependence, and:
* victim's relationship with the perpetrator.
These criteria, individually or in combination, determined APS program
eligibility for older adults. Georgia officials reported, for example,
that an individual must be at least 65 years old to qualify for APS.
Florida officials, on the other hand, reported that an individual must
be at least 60 and unable to care for or protect him-or herself. In
addition, the alleged perpetrator must be a caregiver, family member,
or household member.[Footnote 60]
APS Faces Increasing Numbers and Complexity of Cases:
While there are no national data on trends in the number of elder
abuse cases, APS program officials from six of the nine states we
contacted told us that the number of elder abuse reports and
investigations in their states have been increasing steadily over the
past few years. According to data provided by Virginia and Florida
APS, the number of reports received by Virginia APS increased from
13,515 in 2007 to 17,141 in 2010, and reports received by Florida APS
increased from 43,451 in 2006 to 51,539 in 2008.[Footnote 61],
[Footnote 62] According to our survey, more than half of the states
found that the size of their elder abuse caseloads poses a very great
or great challenge for them. Based on estimates from the 33 states
that could provide this information in our survey, APS conducted more
than 290,000 investigations of elder abuse in state fiscal year 2009
(see table 3).[Footnote 63],[Footnote 64]
Table 3: APS Estimates of Reports Received, Investigations, and
Substantiations in State Fiscal Year 2009:
Reports received[A];
Number in state fiscal year 2009: 357,000;
Number of states responding: 31.
Investigations;
Number in state fiscal year 2009: 292,000;
Number of states responding: 33.
Substantiations;
Number in state fiscal year 2009: 95,000;
Number of states responding: 27.
Source: GAO survey of APS programs.
[A] States provided data on reports received prior to any screening
for eligibility.
[End of table]
An agency official noted that data on investigations only represent
those cases that are reported to APS, and that the actual number of
elder abuse incidents in a given area may be far greater. Based on
projected population growth among older adults, APS elder abuse
investigations in these 33 states may increase 28 percent by 2020 and
50 percent by 2030.[Footnote 65]
Further, APS officials from five of the nine states we contacted told
us their cases are becoming more complex, and therefore more
challenging to investigate and resolve. According to APS program
officials and subject matter experts, cases more frequently involve
several forms of elder abuse, including financial exploitation;
multiple perpetrators; intellectual disabilities; diminished
cognition; and/or substance abuse on the part of the victim or
perpetrator. For example, program officials and subject matter experts
noted that older adults are living longer, which increases their
likelihood for cognitive and physical deterioration. These factors can
make cases more complex and in need of increasingly comprehensive APS
interventions. These cases may also require more post-investigative
services. In our survey, 38 states noted that providing continuing
case management after investigations are complete poses a very great
or great challenge for them.
Lack of Financial Resources Impedes APS's Ability to Adequately
Respond to Elder Abuse:
While the demand for APS services is increasing substantially and
cases are becoming more complex, APS program officials from six of the
nine states we contacted and several subject matter experts told us
that funding for staffing, training, and public awareness is not
keeping pace.[Footnote 66] In the current economic climate, many state
programs--including APS--have increasingly limited resources. In our
survey, 25 of the 39 states that responded to this question indicated
that total APS funding received from all sources has stayed the same
or decreased over the past 5 years, and program officials also ranked
insufficient funding for program operations as the most significant
challenge they face.
APS is primarily the responsibility of the states, and in 19 of the 28
states that could provide this information in our survey, more than
half of the APS budget in fiscal year 2009 came from state and local
revenues. In five states, the entire APS budget came from state and
local revenues.[Footnote 67] The majority of federal support for APS
is available through Social Services Block Grants (SSBG), available
under Title XX of the Social Security Act, to support of a range of
social services administered by states, including APS.[Footnote 68]
States may choose whether or not to use these funds for APS.
As a result, APS program officials have found it difficult to ensure
adequate staffing levels. Program officials in three states we
contacted told us they do not have enough funding to hire additional
caseworkers to handle increasing caseloads. According to our survey,
33 states indicated there have been freezes on hiring APS caseworkers
in the last year, and 25 states said that APS caseworkers had been
subject to furloughs.[Footnote 69] In addition, APS program officials
told us that when funding decreases, training for caseworkers is often
reduced or eliminated.
Public awareness is important in preventing elder abuse, but program
officials told us they do not have sufficient resources to develop and
implement public awareness campaigns. Program officials from two of
the states we visited and several subject matter experts told us that
public awareness efforts can help increase older adults' knowledge of
elder abuse and how to report it.
APS Programs Lack Access to Information on Resolving Elder Abuse Cases:
According to several APS program officials and subject matter experts,
there is limited information available on how to resolve elder abuse
cases. While some sources provide information that several program
officials said is useful, one subject matter expert told us it is of
limited use because it is not targeted to APS. Officials in two states
told us that as a result, they repeatedly struggle to develop their
own solutions for resolving complex elder abuse cases.
In our survey, nearly all states indicated that APS programs would
benefit from additional information specifically targeted at APS. In
addition, several program officials and subject matter experts told us
there is a great need for more easily accessible and centrally
available information on effective interventions, recommended caseload
sizes, financial exploitation, and appropriate outcomes for APS cases.
[Footnote 70]
State Child Protective Services programs have access to several
federally funded national resource centers, such as the Child Welfare
Information Gateway, the National Resource Center for Child Protective
Services, and the National Child Welfare Resource Center on Legal and
Judicial Issues.[Footnote 71] These centers have provided guidance and
technical assistance to states on topics ranging from promising
practices for Child Protective Services programs to legal and judicial
aspects of the child welfare system.[Footnote 72]
Some APS Programs Lack Adequate Administrative Data Systems:
No nationwide APS administrative data system exists, and each state
has developed its own. We found that some APS programs face challenges
in collecting, maintaining, and reporting statewide case-level
administrative data, and data collected by states are not uniform.
Program officials and subject matter experts we met with told us these
data are critical in order to understand programmatic trends, such as
characteristics of the populations in the state that are most
vulnerable to abuse and changes in caseload composition.
Administrative data can also provide information on the outcomes of
certain interventions, which is an important first step in determining
how effective they may be. Since states vary in the reliability of
their APS administrative data systems as well as in what data they
collect, APS program officials and elder abuse experts told us that
APS programs would benefit from a national system for collecting and
maintaining uniform APS data, as it would allow them to target
efforts, appropriately allocate funds, and share practices.
While nearly all states reported in our survey that they use an
automated data collection and management system for elder abuse data,
the value of these data systems in providing information on APS
caseloads varies. For example, 11 survey respondents expressed concern
about inaccurate and incomplete entry of APS data in their data
collection and management systems. An official from one state told us
that high caseloads limit the amount of time caseworkers can spend
inputting data, which may adversely affect the accuracy and quality of
data that are entered into the system. States also noted that
weaknesses in their existing systems hinder their ability to maintain
the data they need. For example, officials from Florida told us that
APS shares a data system that was specifically developed for Child
Protective Services programs and as a result, does not capture all the
data elements APS needs.
In addition, the case-level data that APS programs collect vary by
state, making it difficult to compile meaningful APS data nationwide.
According to a national elder abuse organization, this has impeded the
comparison of administrative data across states. Program officials
from three of the nine states we contacted said that uniform
administrative data across states would be useful, as it would allow
them to assess their program performance in relation to other states
and consider how to most effectively allocate their own resources.
Lack of Collaboration between APS and its Partners Can Impede Response
in Elder Abuse Cases:
APS program officials and subject matter experts told us that the
involvement of the criminal justice system and other partners in the
elder abuse field is not always adequate, which can impede APS
programs' ability to effectively and efficiently resolve elder abuse
cases. According to a recent study, multidisciplinary collaboration is
considered to be a best practice for addressing elder abuse. Subject
matter experts noted that because of the complex nature of elder abuse
and the responses required to assist victims, a collaborative approach
can achieve better outcomes than a single-discipline response.
[Footnote 73] Members of local multidisciplinary elder abuse teams
reported that their teams helped them more accurately assess cases of
elder abuse, and improved their knowledge about the indicators of
abuse.
The criminal justice system and financial institutions, in particular,
play an important role in supporting APS programs as they address and
resolve elder abuse cases. Law enforcement may be called upon to
assist APS investigations, and prosecutors can try these cases in
court. However, several program officials in the states we visited
told us that the effectiveness of APS coordination with the criminal
justice systems varies. According to two officials we spoke with, when
faced with competing demands on their time, law enforcement may not be
able to support APS investigations to the extent APS believes is
necessary, and prosecutors may be unwilling or unable to prosecute
elder abuse cases. In our survey, 20 states reported that obtaining
assistance from law enforcement in investigating alleged elder abuse
cases poses a very great or great challenge for them, and 23 of the 35
states that responded to this question indicated that few, if any, of
all substantiated elder abuse cases referred to law enforcement
authorities are prosecuted.
In addition, although program officials from three of the six states
we visited and several subject matter experts told us that financial
institutions can be reluctant to provide APS with support in
investigating and resolving elder financial exploitation due to
privacy concerns, coordination with such institutions is particularly
critical because APS caseworkers often lack the expertise to
adequately respond to financial exploitation. In financial
exploitation cases, APS caseworkers must work with professionals from
other disciplines to collect and verify a variety of documents,
including bills, financial statements, and deeds. Texas APS, for
example, employs subject matter experts who assist caseworkers with
financial exploitation cases. However, APS officials from other states
told us they are unable to do so because of resource constraints.
According to our survey, only 4 states said that the support available
to them from the criminal justice system to identify and investigate
suspected financial exploitation of older adults was sufficient to a
very great or great extent. Program officials also told us that by the
time APS becomes involved in financial exploitation cases, victims'
money may already be gone, with little hope of restitution. Thus,
success in these cases is commonly measured in terms of preventing
additional theft or further exploitation, rather than recovering any
money lost.
In response to these coordination challenges, APS program officials
and elder abuse experts told us that information related to developing
multidisciplinary teams and collaborating with partners would assist
APS and its partners in effectively investigating and resolving elder
abuse cases.
Federal Elder Justice Activities Have Provided Some Support to APS,
but Federal Leadership Is Lacking:
Federal Elder Justice Activities Are Scattered across Several Agencies:
Between fiscal years 2005 and 2009, four agencies within HHS and four
within Justice funded elder justice activities that could help address
elder abuse nationwide.[Footnote 74] Table 4 provides an overview of
the types of elder justice activities and federal support devoted to
each activity from fiscal year 2005 through 2009.
Table 4: Federal Elder Justice Activities, Fiscal Years 2005-2009:
Elder justice activity: Develop and deliver training related to elder
abuse;
Source and nature of federal support: National Center on Elder Abuse
(NCEA) grants to deliver online training on topics ranging from Adult
Protective Services (APS) worker safety to financial exploitation;
Agency/Department: Administration on Aging (AoA)/Department of Health
and Human Services (HHS).
Elder justice activity: Develop and deliver training related to elder
abuse;
Source and nature of federal support: Enhanced Training and Services
to End Violence and Abuse of Women Later in Life Program grants for
the development and delivery of training related to detecting and
responding to elder abuse for law enforcement, attorneys, judges, APS
program staff, medical professionals, and others, such as through the
Florida Elder Abuse Training Initiative;
Agency/Department: Office on Violence Against Women/Department of
Justice (Justice).
Elder justice activity: Develop and deliver training related to elder
abuse;
Source and nature of federal support: Victims of Crime Act and
American Recovery and Reinvestment Act grants for the development and
delivery of training related to detecting and responding to elder
abuse for law enforcement, attorneys, judges, APS program staff,
medical professionals, and others;
Agency/Department: Office for Victims of Crimes/Justice.
Elder justice activity: Promote elder abuse prevention and awareness;
Source and nature of federal support: Older Americans Act formula
grants to state agencies on aging for prevention and public awareness
of elder abuse. State agencies on aging may devote some or all of this
funding to APS programs;
Agency/Department: AoA/HHS.
Elder justice activity: Promote elder abuse prevention and awareness;
Source and nature of federal support: NCEA grants for the collection
and dissemination of information, research, and other materials on
elder abuse, and for developing and disseminating elder abuse
awareness materials;
Agency/Department: AoA/HHS.
Elder justice activity: Provide information and guidance for APS
programs;
Source and nature of federal support: NCEA grants to collect and
disseminate information, research, and other materials on elder abuse,
such as through online databases, an e-mail listserv, and a monthly
newsletter;
Agency/Department: AoA/HHS.
Elder justice activity: Provide information and guidance for APS
programs;
Source and nature of federal support: National Institute on Aging
grants for research related to elder abuse on topics such as assessing
and detecting elder abuse;
Agency/Department: National Institutes of Health/HHS.
Elder justice activity: Provide information and guidance for APS
programs;
Source and nature of federal support: National Institute of Justice
grants for research related to elder abuse on topics such as forensic
markers of physical abuse;
Agency/Department: National Institute of Justice/Justice.
Elder justice activity: Help establish a uniform nationwide APS
administrative data system[A];
Source and nature of federal support: Centers for Disease Control and
Prevention (CDC) effort to develop common definitions of elder abuse
and determine what data elements a uniform, nationwide elder abuse
data system should collect;
Agency/Department: CDC/HHS.
Elder justice activity: Help establish a uniform nationwide APS
administrative data system[A];
Source and nature of federal support: Office of the Assistant
Secretary for Planning and Evaluation grant to study the feasibility
of establishing a uniform national data collection system for elder
abuse;
Agency/Department: Office of the Assistant Secretary for Planning and
Evaluation/HHS.
Elder justice activity: Promote multidisciplinary collaboration in
responding to elder abuse[B];
Source and nature of federal support: NCEA grants for a manual on
developing multidisciplinary elder abuse teams, and funds for over 30
such teams in localities across the nation;
Agency/Department: AoA/HHS.
Elder justice activity: Promote multidisciplinary collaboration in
responding to elder abuse[B];
Source and nature of federal support: Victims of Crime Act grant to
develop a manual for establishing multidisciplinary elder abuse
fatality review teams;
Agency/Department: Office for Victims of Crimes/Justice.
Elder justice activity: Promote multidisciplinary collaboration in
responding to elder abuse[B];
Source and nature of federal support: Elder Justice Initiative grant
to identify barriers related to elder abuse prosecutions;
Agency/Department: Civil Division/Justice.
Elder justice activity: Support research related to the incidence and
prevalence of elder abuse;
Source and nature of federal support: National Institute on Aging
grants for research to develop and test methods for measuring the
incidence and prevalence of elder abuse;
Agency/Department: National Institutes of Health/HHS.
Elder justice activity: Support research related to the incidence and
prevalence of elder abuse;
Source and nature of federal support: National Institute of Justice
grants for research to develop and test methods for measuring the
incidence and prevalence of elder abuse;
Agency/Department: National Institute of Justice/Justice.
Source: GAO analysis of federal elder justice activities based on
interviews with federal officials and related agency documents.
[A] Justice's Bureau of Justice Statistics and National Institute of
Justice recently issued a grant to compare administrative data on
elder abuse from a number of sources, including APS.
[B] Justice's Bureau of Justice Assistance also provided a grant in
fiscal year 2010 to develop and disseminate a pocket guide for those
working in state and local justice systems on legal issues related to
elder abuse. The guide will include topics such as powers of attorney,
financial exploitation, legal responsibilities of fiduciaries,
capacity issues, informed consent, and undue influence in elder abuse
cases. It is expected to be available in August 2011.
[End of table]
Of the federal elder justice activities described above, only the OAA
formula grants for prevention and public awareness of elder abuse
could be used to fund APS operations from fiscal year 2005 through
fiscal year 2009.[Footnote 75] Other activities may have indirectly
supported APS during that time, but did not provide any direct funding
for APS operations.[Footnote 76]
In fiscal year 2009, programs in seven federal agencies expended a
total of $11.9 million on elder justice activities. Figure 2 provides
an overview of federal sources of funding and the amounts each
expended on these activities that year.
Figure 2: Federal Funding Agencies Spent on Elder Justice Activities
by Department and Agency, Fiscal Year 2009:
[Refer to PDF for image: illustration of differing sized circles]
Dept. of Health and Human Services ($7.0 million total):
Administration on Aging: $5.9 million;
National Institute on Aging: $1.1 million;
Centers for Disease Control and Prevention: $50,000.
Dept. of Justice ($4.9 million total):
Office on Violence Against Women: $3.1 million;
National Institute of Justice: $1.2 million[A];
Office for Victims of Crimes: $516,000;
Civil Division: $75,000.
Source: GAO analysis of federal funding for elder justice activities
based on agency documents and interviews with federal officials.
Note: Size of the circles in Figure 2 are proportional to amount of
funding by agency in fiscal year 2009. While the Office of the
Assistant Secretary for Planning and Evaluation completed elder
justice-related work in fiscal year 2009, funding for this work was
provided in fiscal year 2006.
[A] Of this amount, $650,000 came from the Civil Division's funding
for elder abuse research.
[B] The Civil Division also expended $361,000 in fiscal year 2009 for
hiring staff to provide legal and law enforcement support for cases of
elder abuse in institutions, although this was outside the scope of
our study.
[End of figure]
About half of the total federal investment in elder justice activities
in fiscal year 2009 came from AoA through the OAA. Most AoA elder
justice funding ($5 million) was expended on formula grants to all
state agencies on aging to (1) promote public awareness of how to
identify and prevent elder abuse, and (2) coordinate state agency on
aging and APS activities.[Footnote 77]
Federal Activities Have Helped Address Some APS Challenges:
State APS programs ranked a lack of financial resources as their
greatest challenge in our survey, and no federal funding is currently
dedicated exclusively to APS programs. As mentioned above, AoA
provides OAA formula grants to state agencies on aging for elder abuse
prevention and awareness. While state agencies on aging can allocate
these funds to APS programs, AoA does not require state agencies on
aging to report how the funds were used. Of the 40 states that could
provide this information in our survey, 15 stated that they had
received OAA funds to support their APS programs. These states
received a total of $1.7 million in OAA funds in fiscal year 2009. The
EJA authorized $100 million in formula grants to state APS programs
for each of fiscal years 2011 through 2014. However, as of March 2,
2011, no EJA funding had been appropriated.[Footnote 78]
SSBG funds and Medicaid funds appear to be the largest sources of
federal funding for APS programs.[Footnote 79] Although the federal
government does not require states to provide information on the
portion of SSBG funds they allocate specifically to APS programs,
based on responses to our survey, at least $206.2 million in SSBG
funds was allocated to APS programs in fiscal year 2009.[Footnote 80]
The results of our survey also indicated that APS programs received at
least $42.3 million in Medicaid funds that year.[Footnote 81]
APS programs also indicated they lacked access to information on APS
interventions and practices, and little is available from the federal
government. In fiscal year 2009, AoA provided $811,000 in grants to
run the National Center on Elder Abuse (NCEA), the only federally
funded resource center dedicated to elder abuse issues. Although the
NCEA provides access to a substantial amount of information related to
elder abuse on its Web site and runs a well-regarded listserv for
sharing information, APS program officials in five of the nine states
we contacted told us it provides relatively little information
tailored to the needs of APS programs. For example, the NCEA includes
a database of "promising" practices on a very wide range of topics on
its Web site. However, AoA officials stated that few of these
practices are evidence based,[Footnote 82] as they are primarily
practices submitted by states and others that have not been evaluated
or based on existing research. Most states indicated in our survey
that these practices were of no more than moderate use to them. In
general, most states noted that the NCEA's assistance in developing
their APS programs was of no more than some use to them.
AoA officials told us the NCEA Web site does not contain key
information on interventions and practices that would be useful to APS
programs, in part, because there is a lack of research establishing
evidence-based practices related to APS. The EJA authorizes funding
for elder abuse research that could help develop such practices, and
thus enhance such information for state APS programs. More
specifically, it authorized $25 million in fiscal year 2011 for HHS to
provide grants for state demonstration projects on detecting or
preventing elder abuse and $4 million in that year to create
multidisciplinary forensic centers that would conduct research and
develop forensic expertise on elder abuse, including indicators of
elder abuse, methodologies for assessing it, and information on
interventions, among other things. It also authorizes $3 million in
fiscal year 2011 for HHS to develop and disseminate information on
best practices and conduct research on APS programs, among other
things.
AoA has been required by law since 2006 to develop objectives,
priorities, policy, and a long-term plan for establishing federal
guidelines for state-level uniform data collection and for working
with states and federal agencies to annually collect and disseminate
elder abuse data, to the extent practicable.[Footnote 83] However, it
has taken only limited steps to do so. For example, according to AoA
officials, AoA has supported a recent Centers for Disease Control and
Prevention (CDC) effort to develop uniform definitions for public
health surveillance of elder abuse, which may help identify common
data elements for APS administrative data collection.[Footnote 84] AoA
officials also told us that AoA supported NCEA studies of APS data in
the past, as well as reviewed model definitions of elder abuse. While
these actions and others taken by AoA[Footnote 85] may have helped
begin to lay the groundwork for establishing a national APS data
collection system, they have not resulted in documented objectives,
priorities, policies, or plans for doing so, as called for in the OAA
in 2006.
Despite the OAA provisions mentioned above, concerns on the part of
AoA about the practicability of collecting such data (as opposed to
planning for its collection) seem to be impeding progress in this
area. AoA officials we spoke with indicated that it was not currently
practicable for their agency to require all APS programs to provide
them with administrative data because many of the programs do not
receive AoA elder abuse formula grant funding. Only 15 out of 40 state
APS programs that were able to provide this information in our survey
indicated that they received OAA funding through these AoA grants in
fiscal year 2009. In addition, AoA officials expressed concern that
the total amount of elder abuse formula grants provided to state
agencies on aging may not justify the burden that reporting
administrative data places on state APS programs. Moreover, AoA
officials noted that it has been difficult to establish a nationwide
data collection system because there is no common state-level
definition of elder abuse.
The federal government has been involved in improving and compiling
state administrative data in similar areas in the past. For example,
in the field of child welfare, HHS used a contractor to organize
meetings with representatives from each state to reach consensus on
what data elements to collect in developing the National Child Abuse
and Neglect Data System. This system has been used by states to
collect and report child abuse data nationwide.[Footnote 86] HHS has
continued to host annual technical assistance meetings with states to
clarify what is being collected, discuss challenges with data
collection, and produce a report based on case-level data.
As noted earlier, the EJA authorizes $100 million in grants for APS
programs.[Footnote 87] The EJA requires states that receive a grant to
report the number of elder abuse cases served using this funding. No
other reporting requirements are specified in the law. In addition,
some of the $3 million authorized under the EJA for elder abuse
guidance and research could also be used to develop a nationwide APS
data collection system.
Federal activities also support a multidisciplinary approach for
responding to elder abuse that can help promote collaboration between
APS programs and its partners. Since 2007, the NCEA has funded a
project for developing community elder justice coalitions and for
producing a manual others may use to start such multidisciplinary
teams. To date, this project has established 40 such coalitions around
the country. The Office for Victims of Crimes also funded the
development of a manual for starting multidisciplinary elder abuse
fatality review teams that identify the causes of deaths so they can
be prevented in the future.[Footnote 88] In addition, Justice's Office
for Victims of Crimes' and Office on Violence Against Women's training
on elder abuse has provided opportunities for law enforcement
officers, attorneys, judges, medical professionals, and APS workers to
build working relationships.
Leadership of Elder Justice Activities across Federal Agencies Is
Lacking:
Although the OAA has called attention to the importance of federal
leadership in the elder justice area,[Footnote 89] no national policy
priorities currently exist. The only federal effort to establish such
priorities occurred in 2001, when AoA and the Office for Victims of
Crimes sponsored a summit through NCEA grantees to develop a national
elder abuse policy agenda.[Footnote 90] This resulted in several
action items that were relevant to the delivery of APS programs,
including:
* developing and implementing a national elder abuse training
curriculum that can be used by a variety of professionals;
* creating a national APS resource center that provides guidance on
best practices for APS programs; and:
* increasing collaboration between law enforcement, prosecutors,
judges, medical professionals, and APS programs when intervening in
elder abuse cases.
AoA officials noted that while AoA funded this effort, it has not
endorsed these action items as national elder abuse policy priorities.
Moreover, our survey and interviews with federal officials and elder
abuse experts indicated that a lack of training, information, and
multidisciplinary collaboration continue to be challenges for APS
programs.
In addition to this summit, the National Institute on Aging and the
National Institute of Justice have convened experts and researchers on
several occasions over the past decade to propose priorities
specifically for elder abuse research (see table 5).
Table 5: History of Federal Efforts to Identify Elder Abuse Research
Priorities, Fiscal Years 2000-2010:
Year: 2000;
Sponsor(s): National Institute of Justice;
Effort and purpose: Conference to identify priorities for elder abuse
research.
Year: 2003;
Sponsor(s): National Institute on Aging;
Effort and purpose: Expert panels to identify priorities for elder
abuse research[A].
Year: 2008;
Sponsor(s): National Institute of Justice;
Effort and purpose: Conference to identify priorities for elder abuse
research.
Year: 2010;
Sponsor(s): National Institute on Aging;
Effort and purpose: Conference to identify priorities for elder abuse
research.
Source: GAO analysis of federal efforts to identify elder abuse
research priorities based on interviews with federal officials and
related agency documents.
[A] Panels were convened by the National Research Council, which
functions under the auspices of the National Academy of Sciences,
National Academy of Engineering, and Institute of Medicine, and
nonprofit organizations that provide advice on the scientific and
technological issues that could affect national policy.
[End of table]
Each of these efforts has established a number of priorities for elder
justice researchers in general that have been consistent over time.
For example, the National Research Council expert panels resulted in a
book published in 2003 with many recommendations.[Footnote 91] One was
to conduct population-based surveys to measure the incidence of elder
abuse because the experts indicated that such information is
critically needed to develop appropriate and effective policies to
address elder abuse. All other conferences to identify priorities for
elder abuse research also developed similar recommendations. However,
no comprehensive national incidence study has been undertaken to date.
In addition, all these efforts resulted in recommendations to place
priority on research to establish APS evidence-based practices, but
APS programs continue to identify evidence-based practices as a major
need.
Under the OAA, AoA is the primary federal agency responsible for
providing national leadership in the elder justice area.[Footnote 92]
A senior AoA official told us that, while the agency has met its
responsibilities, its funding levels limit its elder justice
activities.[Footnote 93] The official noted that AoA has established
the Technical Assistance and Support Center to help state agencies on
aging develop priorities for older adult programs. In addition, AoA
has coordinated with other federal agencies to help facilitate elder
justice activities by attending meetings hosted by others and
participating in an informal interagency workgroup that shares
information regarding each agency's elder abuse activities.[Footnote
94] With regard to OAA's requirement that AoA support a study that
estimates the extent of elder abuse, neglect, and exploitation in all
settings nationwide, the agency has helped the National Institute on
Aging develop initiatives for research that test methods for
determining the extent of elder abuse.[Footnote 95] Although the
results of this research, along with CDC's inclusion of elder abuse
questions in its survey of intimate partner violence, have helped lay
the groundwork for a comprehensive study of the extent of elder abuse
nationwide, there are no plans to conduct such a study as of March 2,
2011.[Footnote 96]
The EJA reaffirmed the importance of federal leadership of elder
justice activities and provides a vehicle for establishing and
implementing national priorities in this area. The Elder Justice
Coordinating Council--consisting of the Secretary of HHS, Attorney
General, and heads of related federal offices--is charged with making
recommendations to the Secretary of HHS for the coordination of
activities between federal agencies.[Footnote 97] In addition, the
Council is to report to Congress on its activities, accomplishments,
and challenges as well as make recommendations for legislative or
other actions within 2 years of enactment and every 2 years
thereafter. The Advisory Board on Elder Abuse, Neglect, and
Exploitation--consisting of 27 members from the general public with
elder abuse expertise as appointed by the Secretary of HHS--is charged
with proposing priorities for the field of elder justice.[Footnote 98]
The Advisory Board is to report on the status of elder justice
activities and provide recommendations for developing the field of
elder abuse to the Council and Congress within 18 months of enactment
and annually thereafter.
As of March 2, 2011, HHS had solicited nominations for Board members
and drafted timelines to convene meetings for both the Council and the
Board. However, HHS had not appointed Council members, and no funding
had been appropriated for these activities.
Conclusions:
Elder abuse physically and emotionally harms older Americans and can
deprive them of the unrecoverable financial resources they rely on to
help them care for themselves in old age. It can occur in any
community and can involve older adults in any socioeconomic, racial,
or ethnic group. While current public policies encourage adults to
remain in their homes as they age, the system in place to protect them
may not be able to meet the needs of the increasing number of older
Americans.
State APS programs face daunting challenges in responding to and
preventing elder abuse. While a number of federal agencies have made
efforts to help states address these challenges, federal elder justice
activities have been scattered across agencies and, as a whole, have
had a limited impact on the elder justice field--a clear indication
that federal leadership in this area has been lacking. In addition,
while there are a number of federal activities that focus on elder
justice, the amount of federal funding for all activities in this area
in fiscal year 2009 was only $11.9 million, little of which appears to
have gone directly to APS programs. The EJA provides a vehicle for
setting national priorities and establishing a comprehensive,
multidisciplinary elder justice system in this country. It also
charges HHS to administer grants to state APS programs that could help
them overcome the challenges they face.[Footnote 99] However, funding
for activities identified in the EJA had not been appropriated as of
March 2, 2011.
While the federal government provides some information on effective
interventions and appropriate outcomes in elder abuse cases, states
noted that it is not sufficient given the growing demand for APS
services and the increasing complexity of APS cases, and more is
needed in these areas. Without adequate evidence-based information on
interventions and practices, these programs may be unable to use the
limited resources available to them effectively.
AoA has not fulfilled its requirement under the OAA to develop
objectives, priorities, policy, and a long-term plan for establishing
federal guidelines for uniform data collection or for working with
state and federal entities to annually collect this data. Without
these data, states cannot benefit from their collective experience in
this area. Moreover, the federal government will not have the
information needed to oversee EJA funding dedicated to APS programs or
to support research for developing the information needed by APS.
While the EJA establishes a mechanism for state APS programs to share
data with the federal government by requiring states to report on the
number of elder abuse cases served using the EJA grants dedicated to
APS programs,[Footnote 100] it does not require HHS to collect other
APS data that may help address the challenges described above, such as
types of abuse, types of interventions carried out, and demographic
data of victims and perpetrators. In developing a system for
collecting, compiling, and disseminating such data, nationwide,
federal and state collaboration is crucial--as federal experience in
developing national child welfare data systems has shown--and pilot
testing would help determine the feasibility and cost of such a system.
It should be recognized that improvements in APS systems and response
methods may not substantially increase capacities for detecting and
responding to those elder abuse cases that are not reported to APS.
Identifying and measuring the extent and characteristics of elder
abuse in the population will require other methods, such as elder
abuse surveillance. While a number of federal officials and experts
have recognized the importance of periodically collecting complete,
consistent data on the extent of elder abuse so changes in its extent
and form can be tracked over time, this has not been done to date.
Although CDC considers elder abuse a growing public health problem,
there is no ongoing surveillance of its extent similar to periodic
national incidence studies of child abuse and neglect. Without
periodically measuring the extent of elder abuse nationwide, it will
be difficult to develop an effective national policy for its
prevention as required under the OAA.[Footnote 101] CDC's efforts to
create common definitions for elder abuse and to integrate questions
on elder abuse into one of its existing surveys, as well as past
research on elder abuse prevalence, have provided a foundation for
ongoing national surveillance of elder abuse. Additional legislation
could ensure that such a study is conducted periodically over time.
Recommendations for Executive Action:
To help APS programs more effectively and efficiently respond to elder
abuse, we recommend that the Secretary of HHS determine the
feasibility and cost of establishing a national resource center for
APS-dedicated information that is comprehensive and easily accessible.
To facilitate the development of a nationwide APS data collection
system, we recommend that the Secretary of HHS direct AoA to develop a
comprehensive long-term plan for implementing such a system within a
reasonable amount of time.
To ensure federal and state collaboration in planning and implementing
such a system, we recommend that the Secretary of HHS, in coordination
with the Attorney General, convene a group of state APS
representatives to help determine what APS administrative data on
elder abuse cases would be most useful for all states and for the
federal government to collect; what APS administrative data all states
should uniformly collect; and how a system for compiling and
disseminating nationwide data should be designed.
To determine the feasibility and cost of collecting uniform, reliable
APS administrative data on elder abuse cases from each state, and
compiling and disseminating that data nationwide, we recommend that
the Secretary of HHS, in coordination with the Attorney General,
conduct a pilot study to collect, compile, and disseminate these data.
Matter for Congressional Consideration:
The Congress should consider mandating the Secretary of HHS to
conduct, in coordination with the Attorney General, a periodic
national study of elder abuse's extent to track it over time.
Agency Comments:
We provided a draft of our report to Justice and HHS for review and
comment. HHS indicated in its general comments (see appendix IX) that
our report accurately depicts elder justice efforts across the
country, notes that there are substantial gaps in elder abuse
research, and presents useful information on factors that may place
older adults at greater risk of abuse. HHS believes, however, that the
report does not recognize the importance of understanding the factors
associated with carrying out elder abuse (perpetration) because it
emphasizes characteristics that may increase victims' risk of being
abused. We agree that understanding the factors associated with
perpetration of abuse in order to prevent abuse before it begins is
vital. We note in the report that some factors, such as mental
illness, may characterize perpetrators as well as victims. HHS also
described the NCEA's role in preventing elder abuse and the role OAA
formula grants play in supporting community-based efforts in this
area. It acknowledged AoA's responsibilities under the OAA and noted
steps AoA has taken, in collaboration with other agencies in HHS, to
lay the foundation for surveillance of elder abuse and collection of
APS administrative data, nationwide. HHS noted, however, that it is
important to balance the burden compiling APS administrative data
would impose on states with its potential benefits. With regard to our
recommendations, HHS indicated it will review and explore options for
implementing them. Both HHS and Justice provided technical comments
that we incorporated into the report, as appropriate.
We are sending copies of this report to HHS and Justice, relevant
congressional committees, and other interested parties. We will also
make copies available to others upon request. The report is available
at no charge on GAO's Web site at [hyperlink, http://www.gao.gov].
If you or your staff have any questions about this report, please
contact me at (202) 512-7215 or brownke@gao.gov. Contact points for
our Offices of Congressional Relations and Public Affairs may be found
on the last page of this report. Key contributors to this report are
listed in appendix X.
Sincerely yours,
Signed by:
Kay E. Brown:
Director, Education, Workforce, and Income Security Issues:
[End of section]
Appendix I: Growth in Percentage of U.S. Elderly Population, 1900-2050:
[Refer to PDF for image: multiple line graph]
Year: 1900;
Age 85 and older: 0.2;
Age 60 and older: 6.4;
Age 65 and older: 4.1.
Year: 1910;
Age 85 and older: 0.2;
Age 60 and older: 6.8;
Age 65 and older: 4.3.
Year: 1920;
Age 85 and older: 0.2;
Age 60 and older: 7.5;
Age 65 and older: 4.7.
Year: 1930;
Age 85 and older: 0.2;
Age 60 and older: 8.5;
Age 65 and older: 5.4.
Year: 1940;
Age 85 and older: 0.3;
Age 60 and older: 10.4;
Age 65 and older: 6.8.
Year: 1950;
Age 85 and older: 0.4;
Age 60 and older: 12.2;
Age 65 and older: 8.1.
Year: 1960;
Age 85 and older: 0.5;
Age 60 and older: 13.2;
Age 65 and older: 9.2.
Year: 1970;
Age 85 and older: 0.7;
Age 60 and older: 14.1;
Age 65 and older: 9.9.
Year: 1980;
Age 85 and older: 1;
Age 60 and older: 15.7;
Age 65 and older: 11.3.
Year: 1990;
Age 85 and older: 1.2;
Age 60 and older: 16.8;
Age 65 and older: 12.6.
Year: 2000;
Age 85 and older: 1.5;
Age 60 and older: 16.3;
Age 65 and older: 12.4.
Year: 2010;
Age 85 and older: 1.9;
Age 60 and older: 18.4;
Age 65 and older: 13.
Year: 2020;
Age 85 and older: 1.9;
Age 60 and older: 22.2;
Age 65 and older: 16.1.
Year: 2030;
Age 85 and older: 2.3;
Age 60 and older: 24.7;
Age 65 and older: 19.3.
Year: 2040;
Age 85 and older: 3.5;
Age 60 and older: 25.1;
Age 65 and older: 20.
Year: 2050;
Age 85 and older: 4.3;
Age 60 and older: 25.5;
Age 65 and older: 20.2.
Source: GAO analysis of U.S. Census Bureau data by the Administration
on Aging.
[End of section]
Appendix II: Scope and Methodology:
Survey of State APS Programs:
To assess the activities and challenges faced by state Adult
Protective Services (APS) programs in addressing elder abuse, we
designed and administered a Web-based survey of APS programs in the 50
states and the District of Columbia. Generally, the survey asked
program officials about:
* the administration and organization of APS in their state,
* the population served by APS and the types of abuse that qualify for
services,
* coordination between APS and its multidisciplinary partners,
* the APS data collection and management system(s) in their state,
* funding and federal support received for APS in their state, and:
* the challenges facing APS and any additional federal supports that
are needed.
We also asked program officials to estimate (1) the number of elder
and at-risk adult abuse reports received, (2) the number of elder and
at-risk adult abuse cases investigated, (3) the number of elder and at-
risk adult abuse cases substantiated, and (4) the number of total
active cases. Out of the original population of APS programs in the 50
states and the District of Columbia, we received completed
questionnaires from the 50 state programs--however, not all
respondents provided answers to every question. We did not
independently verify the numbers states provided in each case or the
information pertaining to state laws that was reported by survey
respondents. The survey was administered between June 15, 2010, and
August 19, 2010. Several days before the survey period began, we
notified recipients that they would be receiving it. We also followed
up with nonrespondents several times before the survey period ended.
In developing the questionnaire we took steps to ensure the accuracy
and reliability of responses. We pretested it with officials from five
state APS programs to ensure that questions were clear, comprehensive,
and unbiased, and to minimize the burden the questionnaire placed on
respondents.
In addition to the data from the survey provided in this report and
its appendices, each survey question along with responses to it is
presented in GAO-11-129SP, an electronic supplement to this report.
Literature Review:
To identify research that has estimated the extent of elder abuse and
factors associated with it, we searched Ageline, Wilson Social Science
Abstracts, Medline, and other databases and asked researchers and
subject matter experts in this area. In this way, we selected studies
that either had been sponsored by academic institutions or the federal
government, or had results that were published in peer-reviewed
journals. From this group, we identified more than 50 studies
conducted between 1988 and 2010 that either attempted to measure the
extent of elder abuse or focused on the factors associated with it.
Based on our assessment of the design, measurement strategies, and
limitations of the remaining studies, we eliminated those whose
methods did not conform to generally accepted social science
standards. We identified 4 studies that attempted to examine the
extent of elder abuse nationally. Numerous studies informed our
discussion of the factors associated with elder abuse, and we refer to
14 of these studies in the text.
These studies are all subject to certain methodological limitations.
For example, some studies did not use control groups, while others
relied mainly on self-reports of abuse or its impact.
We conducted this performance audit from November 2009 through
February 2011 in accordance with generally accepted government
auditing standards. These standards require that we plan and perform
the audit to obtain sufficient, appropriate evidence to provide a
reasonable basis for our findings and conclusions based on our audit
objectives. We believe that the evidence obtained provides a
reasonable basis for our findings and conclusions based on our audit
objectives.
[End of section]
Appendix III: Mandatory Reporters to APS of Elder Abuse by State:
State: Alabama;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Alaska;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Arizona;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Check];
No one: [Empty].
State: Arkansas;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Check];
No one: [Empty].
State: California;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Check];
No one: [Empty].
State: Colorado;
Everyone: [Empty];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Check].
State: Connecticut;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Delaware;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Florida;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Georgia;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Check];
No one: [Empty].
State: Hawaii;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Check];
No one: [Empty].
State: Idaho;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Illinois;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Indiana;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Iowa;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Kansas;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Check];
No one: [Empty].
State: Kentucky;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Louisiana;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Maine;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Maryland;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Massachusetts;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Michigan;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Minnesota;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Mississippi;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Missouri;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Check];
No one: [Empty].
State: Montana;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Nebraska;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Nevada;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Check];
No one: [Empty].
State: New Hampshire;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: New Jersey;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: New Mexico;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: New York;
Everyone: [Empty];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Check].
State: North Carolina;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: North Dakota;
Everyone: [Empty];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Check].
State: Ohio;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Oklahoma;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Check];
No one: [Empty].
State: Oregon;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Pennsylvania;
Everyone: [Empty];
Physicians: [Empty];
Home health care providers: [Check];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Rhode Island;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: South Carolina;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Check];
No one: [Empty].
State: South Dakota;
Everyone: [Empty];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Check].
State: Tennessee;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Texas;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Utah;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Vermont;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Virginia;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Washington;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: West Virginia;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Check];
Financial institutions: [Empty];
No one: [Empty].
State: Wisconsin;
Everyone: [Empty];
Physicians: [Check];
Home health care providers: [Check];
Mental health service providers: [Check];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
State: Wyoming;
Everyone: [Check];
Physicians: [Empty];
Home health care providers: [Empty];
Mental health service providers: [Empty];
Law enforcement authorities: [Empty];
Financial institutions: [Empty];
No one: [Empty].
Source: Responses to GAO survey of state APS programs.
[End of table]
[End of section]
Appendix IV: APS Organizational Structure and Location by State:
State: Alabama;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
State: Alaska;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Arizona;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Arkansas;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: California;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
State: Colorado;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
State: Connecticut;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Delaware;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Florida;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Georgia;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Hawaii;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Idaho;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
State: Illinois;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Indiana;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Iowa;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Kansas;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Kentucky;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Louisiana;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Maine;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Maryland;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
[Empty];
Location: APS located within the state agency on aging: [Empty].
State: Massachusetts[A];
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Michigan;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
State: Minnesota;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
State: Mississippi;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Missouri;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Montana;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Nebraska;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Nevada;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: New Hampshire;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: New Jersey;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Check].
State: New Mexico;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: New York;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
State: North Carolina;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Check].
State: North Dakota;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Ohio;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
State: Oklahoma;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Oregon;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
State: Pennsylvania;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Check].
State: Rhode Island;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: South Carolina[B];
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: South Dakota;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Tennessee;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Texas;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Utah;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Vermont;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Check].
State: Virginia;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
State: Washington;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: West Virginia;
Organizational structure: State administered: [Check];
Organizational structure: State supervised: [Empty];
Location: APS located within the state agency on aging: [Empty].
State: Wisconsin;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Check].
State: Wyoming;
Organizational structure: State administered: [Empty];
Organizational structure: State supervised: [Check];
Location: APS located within the state agency on aging: [Empty].
Source: Responses to GAO survey of state APS programs.
[A] Massachusetts did not respond to the survey question about
organizational structure.
[B] South Carolina indicated that APS is administered in some other
way.
[End of table]
[End of section]
Appendix V: Selected APS Eligibility Criteria in Cases of Alleged
Elder Abuse by State:
State: Alabama;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Alaska[B];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Arizona [Highlighted];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Arkansas;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: California;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 65;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Colorado [Highlighted];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Connecticut;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Delaware;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Florida;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Georgia [Highlighted];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Hawaii;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Idaho;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Illinois;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Indiana;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Iowa;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Kansas [Highlighted];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Kentucky;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Louisiana;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 60;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Maine;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Maryland;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 55;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Massachusetts;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 60;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Michigan [Highlighted];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Minnesota;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Mississippi;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Missouri;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Montana;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 60;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Nebraska;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Nevada [Highlighted];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: New Hampshire [Highlighted];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: New Jersey;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: New Mexico [Highlighted];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: New York [Highlighted];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: North Carolina;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: North Dakota[C];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Ohio;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Oklahoma;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Oregon;
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Pennsylvania;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Rhode Island;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 60;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: South Carolina;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: South Dakota;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 60;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Tennessee;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Texas;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 65;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Utah;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 65;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Vermont;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Virginia;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 60;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: Washington [Highlighted];
Can the older adult qualify based on age alone? [Empty];
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
State: West Virginia;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Wisconsin;
Can the older adult qualify based on age alone? Yes;
If yes, age at which older adults qualify for APS: 60;
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Empty];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Empty];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Empty];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Check].
State: Wyoming;
Can the older adult qualify based on age alone? No;
If yes, age at which older adults qualify for APS: [Empty];
If no, other selected APS eligibility criteria: Inability to perform
activities of daily living[A]: [Check];
If no, other selected APS eligibility criteria: Inability to make
responsible decisions for themselves: [Check];
If no, other selected APS eligibility criteria: Dependent on another
for their care: [Check];
If no, other selected APS eligibility criteria: In a relationship of
trust with the alleged perpetrator (for one or more types of abuse
other than self-neglect): [Empty].
Source: Responses to GAO survey of state APS programs.
Note: The eligibility criteria listed in the table do not include all
used to determine APS program eligibility for older adults. States
highlighted had eligibility criteria other than the ones we
specified in our survey.
[A] According to the National Cancer Institute, basic activities of
daily living include eating, dressing, getting into or out of a bed or
chair, taking a bath or shower, and using the toilet. Instrumental
activities of daily living are activities related to independent
living and include preparing meals, managing money, shopping, doing
housework, and using a telephone. The specific definition of
activities of daily living may vary by state.
[B] Alaska indicated that older adults can qualify for APS based on
age alone, but did not specify an age.
[C] North Dakota did not provide information on APS program
eligibility criteria.
[End of table]
[End of section]
Appendix VI: Estimated Elder Abuse Reports to APS, and APS
Investigations and Substantiations in State Fiscal Year 2009:
State: Alabama;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Alaska;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Arizona;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Arkansas;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: California;
Reports of alleged elder abuse received: 76,340;
Elder abuse cases investigated: 58,338;
Elder abuse cases substantiated: 21,300.
State: Colorado;
Reports of alleged elder abuse received: 7,434;
Elder abuse cases investigated: 4,217;
Elder abuse cases substantiated: [Empty].
State: Connecticut;
Reports of alleged elder abuse received: 3,800;
Elder abuse cases investigated: 3,438;
Elder abuse cases substantiated: 446.
State: Delaware;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Florida;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: 29,434;
Elder abuse cases substantiated: 3,905.
State: Georgia;
Reports of alleged elder abuse received: 4,215;
Elder abuse cases investigated: 4,522[A];
Elder abuse cases substantiated: 1,939.
State: Hawaii;
Reports of alleged elder abuse received: 1,189;
Elder abuse cases investigated: 505;
Elder abuse cases substantiated: 81.
State: Idaho;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: 400.
State: Illinois;
Reports of alleged elder abuse received: 10,848;
Elder abuse cases investigated: 9,562;
Elder abuse cases substantiated: 5,809.
State: Indiana;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Iowa;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Kansas;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Kentucky;
Reports of alleged elder abuse received: 12,472;
Elder abuse cases investigated: 9,872;
Elder abuse cases substantiated: 1,973.
State: Louisiana;
Reports of alleged elder abuse received: 3,603;
Elder abuse cases investigated: 3,414;
Elder abuse cases substantiated: 1,953.
State: Maine;
Reports of alleged elder abuse received: 2,613;
Elder abuse cases investigated: 2,312;
Elder abuse cases substantiated: 1,128.
State: Maryland;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: 4,534;
Elder abuse cases substantiated: [Empty].
State: Massachusetts;
Reports of alleged elder abuse received: 15,935;
Elder abuse cases investigated: 11,823;
Elder abuse cases substantiated: 4,738.
State: Michigan;
Reports of alleged elder abuse received: 9,590;
Elder abuse cases investigated: 6,203;
Elder abuse cases substantiated: 1,934.
State: Minnesota;
Reports of alleged elder abuse received: 11,852;
Elder abuse cases investigated: 2,342;
Elder abuse cases substantiated: 320.
State: Mississippi;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Missouri;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Montana;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: 3,865;
Elder abuse cases substantiated: 1,347.
State: Nebraska;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Nevada;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: 3,669;
Elder abuse cases substantiated: 1,167.
State: New Hampshire;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: New Jersey;
Reports of alleged elder abuse received: 4,500;
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: New Mexico;
Reports of alleged elder abuse received: 6,100;
Elder abuse cases investigated: 3,600;
Elder abuse cases substantiated: 1,110.
State: New York;
Reports of alleged elder abuse received: 22,894;
Elder abuse cases investigated: 16,523;
Elder abuse cases substantiated: [Empty].
State: North Carolina;
Reports of alleged elder abuse received: 11,951;
Elder abuse cases investigated: 6,394;
Elder abuse cases substantiated: 2,400.
State: North Dakota;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: 383;
Elder abuse cases substantiated: [Empty].
State: Ohio;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: 16,370;
Elder abuse cases substantiated: [Empty].
State: Oklahoma;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Oregon;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: 3,151;
Elder abuse cases substantiated: [Empty].
State: Pennsylvania;
Reports of alleged elder abuse received: 15,000;
Elder abuse cases investigated: 9,500;
Elder abuse cases substantiated: 2,800.
State: Rhode Island;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: 796;
Elder abuse cases substantiated: [Empty].
State: South Carolina;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: 2,192;
Elder abuse cases substantiated: 1,159.
State: South Dakota;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: 179;
Elder abuse cases substantiated: 116.
State: Tennessee;
Reports of alleged elder abuse received: 6,679;
Elder abuse cases investigated: 6,618;
Elder abuse cases substantiated: 3,516.
State: Texas;
Reports of alleged elder abuse received: 45,460;
Elder abuse cases investigated: 36,710;
Elder abuse cases substantiated: 25,875.
State: Utah;
Reports of alleged elder abuse received: 3,025;
Elder abuse cases investigated: 1,605;
Elder abuse cases substantiated: 142.
State: Vermont;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
State: Virginia;
Reports of alleged elder abuse received: 10,781;
Elder abuse cases investigated: 9,404;
Elder abuse cases substantiated: 5,572.
State: Washington;
Reports of alleged elder abuse received: 12,980;
Elder abuse cases investigated: 11,465;
Elder abuse cases substantiated: 1,157.
State: West Virginia;
Reports of alleged elder abuse received: 8,124;
Elder abuse cases investigated: 4,030;
Elder abuse cases substantiated: 196.
State: Wisconsin;
Reports of alleged elder abuse received: 5,715;
Elder abuse cases investigated: 5,349;
Elder abuse cases substantiated: 2,915.
State: Wyoming;
Reports of alleged elder abuse received: [Empty];
Elder abuse cases investigated: [Empty];
Elder abuse cases substantiated: [Empty].
Source: Responses to GAO survey of state APS programs.
Note: [Empty] refers to instances where the state did not or was
unable to provide this information for fiscal year 2009.
[A] Georgia APS officials noted that investigations are greater than
reports received in fiscal year 2009 because some investigations were
carried over from the previous fiscal year.
[End of table]
[End of section]
Appendix VII: Sources of Funding for APS Operations in 28 States in
State Fiscal Year 2009:
[Refer to PDF for image: horizontal bar graph]
Non-federal sources include State and local revenue or Other non-
federal.
Federal sources include Social Services Block Grants; Medicaid Funds;
Older Americans Act funds; or Other federal funds.
State: Nevada;
Non-federal source: 0%;
Federal sources: 100%.
State: South Carolina;
Non-federal source: 0.4%;
Federal sources: 99.6%.
State: Arizona;
Non-federal source: 27.6%;
Federal sources: 72.4%.
State: Delaware;
Non-federal source: 28.6%;
Federal sources: 71.4%.
State: Maryland;
Non-federal source: 33.4%;
Federal sources: 66.6%.
State: North Carolina;
Non-federal source: 35.7%;
Federal sources: 64.3%.
State: Oklahoma;
Non-federal source: 42.1%;
Federal sources: 57.9%.
State: Mississippi;
Non-federal source: 42.3%;
Federal sources: 57.7%.
State: New York;
Non-federal source: 46.2%;
Federal sources: 53.8%.
State: Virginia;
Non-federal source: 50.8%;
Federal sources: 59.2%.
State: Alabama;
Non-federal source: 56.1%;
Federal sources: 43.9%.
State: Florida;
Non-federal source: 62.3%;
Federal sources: 37.7%.
State: Texas;
Non-federal source: 70.1%;
Federal sources: 29.9%.
State: Washington;
Non-federal source: 0%;
Federal sources: 100%.
State: Colorado;
Non-federal source: 75.9%;
Federal sources: 24.1%.
State: Georgia;
Non-federal source: 81.6%;
Federal sources: 18.4%.
State: New Mexico;
Non-federal source: 83.8%;
Federal sources: 16.2%.
State: Kentucky;
Non-federal source: 84.2%;
Federal sources: 15.8%.
State: Montana;
Non-federal source: 85.2%;
Federal sources: 14.8%.
State: Pennsylvania;
Non-federal source: 93.3%;
Federal sources: 6.7%.
State: Utah;
Non-federal source: 99.1%;
Federal sources: 0.9%.
State: Massachusetts;
Non-federal source: 99.4%;
Federal sources: 0.6%.
State: Maine;
Non-federal source: 99.5%;
Federal sources: 0.5%.
State: Connecticut;
Non-federal source: 1000%;
Federal sources: 0%.
State: Indiana;
Non-federal source: 100%;
Federal sources: 0%.
State: Kansas;
Non-federal source: 100%;
Federal sources: 0%.
State: West Virginia;
Non-federal source: 100%;
Federal sources: 0%.
State: Wyoming;
Non-federal source: 100%;
Federal sources: 0%.
Note: Twenty-two states were unable to provide complete funding
information for their APS programs by source in fiscal year 2009. We
have no information about the amount of their funding relative to the
amount for states that did report. Also, some funding sources may be
too small to appear in the graphic above.
Source: GAO analysis based on responses to GAO survey of state APS
programs.
[End of section]
Appendix VIII: APS Program Budgets by State in State Fiscal Year 2009:
State: Alabama[A];
Total APS program budget: $15,278,239;
Source of APS program funds: Social Services Block Grants: $4,742,087;
Source of APS program funds: Medicaid funds: $1,965,909;
Source of APS program funds: Older Americans Act formula grants: $0;
Source of APS program funds: Other federal funds: $0;
Source of APS program funds: State and local revenue: $8,570,243;
Source of APS program funds: Other nonfederal funds: $0.
State: Alaska [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants:
[Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Arizona;
Total APS program budget: $8,078,259;
Source of APS program funds: Social Services Block Grants: $5,824,695;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
$27,881;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $2,225,683;
Source of APS program funds: Other nonfederal funds: 0.
State: Arkansas [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: $862,842;
Source of APS program funds: Older Americans Act formula grants:
$30,000;
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: California [Highlighted];
Total APS program budget: $127,000,000;
Source of APS program funds: Social Services Block Grants: $61,000,000;
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants:
[Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: $10,000,000.
State: Colorado;
Total APS program budget: $7,900,000;
Source of APS program funds: Social Services Block Grants: $1,900,000;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $6,000,000;
Source of APS program funds: Other nonfederal funds: 0.
State: Connecticut;
Total APS program budget: $800,000;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $800,000;
Source of APS program funds: Other nonfederal funds: 0.
State: Delaware;
Total APS program budget: $35,000;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
$25,000;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $10,000;
Source of APS program funds: Other nonfederal funds: 0.
State: Florida;
Total APS program budget: $55,320,769;
Source of APS program funds: Social Services Block Grants: $4,647,509;
Source of APS program funds: Medicaid funds: $16,225,806;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $34,447,454;
Source of APS program funds: Other nonfederal funds: 0.
State: Georgia;
Total APS program budget: $15,927,320;
Source of APS program funds: Social Services Block Grants: $2,254,539;
Source of APS program funds: Medicaid funds: $678,063;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $12,994,718;
Source of APS program funds: Other nonfederal funds: 0.
State: Hawaii [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: 0.
State: Idaho [Highlighted];
Total APS program budget: $1,385,096;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
$48,697;
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Illinois [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants:
$187,515;
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Indiana;
Total APS program budget: $2,700,000;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $2,700,000;
Source of APS program funds: Other nonfederal funds: 0.
State: Iowa [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: 0.
State: Kansas;
Total APS program budget: $7,253,159;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $7,253,159;
Source of APS program funds: Other nonfederal funds: 0.
State: Kentucky;
Total APS program budget: $12,497,777;
Source of APS program funds: Social Services Block Grants: $1,978,970;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $10,518,807;
Source of APS program funds: Other nonfederal funds: 0.
State: Louisiana [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants:
[Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Maine;
Total APS program budget: $5,327,800;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
$25,000;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $5,302,800;
Source of APS program funds: Other nonfederal funds: 0.
State: Maryland[A];
Total APS program budget: $8,574,363;
Source of APS program funds: Social Services Block Grants: $4,762,847;
Source of APS program funds: Medicaid funds: $169,869;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: $777,809;
Source of APS program funds: State and local revenue: $2,863,838;
Source of APS program funds: Other nonfederal funds: 0.
State: Massachusetts;
Total APS program budget: $17,322,983;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
$109,606;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $14,591,094;
Source of APS program funds: Other nonfederal funds: $2,622,283.
State: Michigan [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Minnesota [Highlighted];
Total APS program budget: $18,476,171;
Source of APS program funds: Social Services Block Grants: $539,504;
Source of APS program funds: Medicaid funds: $14,068,143;
Source of APS program funds: Older Americans Act formula grants:
[Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: $926,887.
State: Mississippi;
Total APS program budget: $1,047,863;
Source of APS program funds: Social Services Block Grants: $270,000;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: $334,563;
Source of APS program funds: State and local revenue: $443,300;
Source of APS program funds: Other nonfederal funds: 0.
State: Missouri [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: 0.
State: Montana;
Total APS program budget: $2,632,013;
Source of APS program funds: Social Services Block Grants: $296,816;
Source of APS program funds: Medicaid funds: $92,327;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $1,926,290;
Source of APS program funds: Other nonfederal funds: $316,580.
State: Nebraska [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: $100,000;
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants:
[Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: $140,086;
Source of APS program funds: Other nonfederal funds: [Empty].
State: Nevada[A];
Total APS program budget: $1,508,284;
Source of APS program funds: Social Services Block Grants: $1,470,592;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
$37,695;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: 0;
Source of APS program funds: Other nonfederal funds: 0.
State: New Hampshire [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants:
[Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: New Jersey [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants:
$155,000;
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: New Mexico;
Total APS program budget: $15,506,700;
Source of APS program funds: Social Services Block Grants: $2,498,600;
Source of APS program funds: Medicaid funds: $12,700;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $12,995,400;
Source of APS program funds: Other nonfederal funds: 0.
State: New York;
Total APS program budget: $122,588,840;
Source of APS program funds: Social Services Block Grants: $66,000,000;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $56,588,840;
Source of APS program funds: Other nonfederal funds: 0.
State: North Carolina;
Total APS program budget: $14,851,478;
Source of APS program funds: Social Services Block Grants: $9,552,356;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $5,299,122;
Source of APS program funds: Other nonfederal funds: 0.
State: North Dakota [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
[Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Ohio [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: $13,394,830;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
[Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Oklahoma;
Total APS program budget: $14,661,994;
Source of APS program funds: Social Services Block Grants: $5,678,221;
Source of APS program funds: Medicaid funds: $2,809,938;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $6,173,835;
Source of APS program funds: Other nonfederal funds: 0.
State: Oregon [Highlighted];
Total APS program budget: $7,700,000;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Pennsylvania;
Total APS program budget: $12,000,000;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
$800,000;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $11,200,000;
Source of APS program funds: Other nonfederal funds: 0.
State: Rhode Island [Highlighted];
Total APS program budget: $940,495;
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants:
$54,080;
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: South Carolina;
Total APS program budget: $3,566,304;
Source of APS program funds: Social Services Block Grants: $3,553,258;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $13,046;
Source of APS program funds: Other nonfederal funds: 0.
State: South Dakota [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants:
[Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Tennessee [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants: [Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Texas;
Total APS program budget: $50,802,261;
Source of APS program funds: Social Services Block Grants: $12,361,183;
Source of APS program funds: Medicaid funds: $2,853,913;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $35,587,165;
Source of APS program funds: Other nonfederal funds: 0.
State: Utah;
Total APS program budget: $2,800,000;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
$24,000;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $2,600,000;
Source of APS program funds: Other nonfederal funds: $176,000.
State: Vermont [Highlighted];
Total APS program budget: $782,501;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants:
[Empty];
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Virginia[A];
Total APS program budget: $6,797,618;
Source of APS program funds: Social Services Block Grants: $3,345,533;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: $1,000;
Source of APS program funds: State and local revenue: $3,452,085;
Source of APS program funds: Other nonfederal funds: 0.
State: Washington;
Total APS program budget: $7,424,282;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: $2,084,000;
Source of APS program funds: Older Americans Act formula grants:
$99,282;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $5,241,000;
Source of APS program funds: Other nonfederal funds: 0.
State: West Virginia;
Total APS program budget: $6,723,615;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $6,723,615;
Source of APS program funds: Other nonfederal funds: 0.
State: Wisconsin [Highlighted];
Total APS program budget: [Empty];
Source of APS program funds: Social Services Block Grants: [Empty];
Source of APS program funds: Medicaid funds: [Empty];
Source of APS program funds: Older Americans Act formula grants:
$92,156;
Source of APS program funds: Other federal funds: [Empty];
Source of APS program funds: State and local revenue: [Empty];
Source of APS program funds: Other nonfederal funds: [Empty].
State: Wyoming;
Total APS program budget: $210,081;
Source of APS program funds: Social Services Block Grants: 0;
Source of APS program funds: Medicaid funds: 0;
Source of APS program funds: Older Americans Act formula grants: 0;
Source of APS program funds: Other federal funds: 0;
Source of APS program funds: State and local revenue: $210,081;
Source of APS program funds: Other nonfederal funds: 0.
State: Number of states responding;
Total APS program budget: 35;
Source of APS program funds: Social Services Block Grants: 38;
Source of APS program funds: Medicaid funds: 38;
Source of APS program funds: Older Americans Act formula grants: 40;
Source of APS program funds: Other federal funds: 31;
Source of APS program funds: State and local revenue: 29;
Source of APS program funds: Other nonfederal funds: 34.
State: Total;
Total APS program budget: $576,421,265;
Source of APS program funds: Social Services Block Grants:
$206,171,540;
Source of APS program funds: Medicaid funds: $41,823,510;
Source of APS program funds: Older Americans Act formula grants:
$1,715,912;
Source of APS program funds: Other federal funds: $1,113,372;
Source of APS program funds: State and local revenue: $256,871,661;
Source of APS program funds: Other nonfederal funds: $14,041,750.
Source: GAO analysis based on responses to GAO survey of state APS
programs.
Note: States highlighted could not provide completed funding
information from all sources in fiscal year 2009.
[A] For Alabama, Maryland, Nevada, and Virginia, the difference
between the sum of the sources of APS program funds and the total APS
program budget is less than $1,000; thus, we considered these states
as those that could provide complete funding information in fiscal
year 2009.
[End of table]
[End of section]
Appendix IX: Comments from the Department of Health and Human Services:
Department of Health and Human Services:
Office of The Secretary:
Assistant Secretary for Legislation:
Washington, DC 20201:
February 24, 2011:
Kay E. Brown:
Director, Education, Workforce, and Income Security Issues:
U.S. Government Accountability Office:
441 G Street N.W.
Washington, DC 20548:
Dear Ms. Brown:
Attached are comments on the U.S. Government Accountability Office's
(GAO) draft report entitled, "Elder Justice: Stronger Federal
Leadership Could Enhance National Response to Elder Abuse" (GA0-11-208).
The Department appreciates the opportunity to review this report prior
to publication.
Sincerely,
Signed by:
Jim R. Esquea:
Assistant Secretary for Legislation:
Attachment:
[End of letter]
General Comments Of The Department Of Health And Human Services (HHS)
On The U.S. Government Accountability Office's (GAO) Draft Report
Entitled, "Elder Justice: Stronger Federal Leadership Could Enhance
National Response To Elder Abuse" (GAO-11-208):
The Department appreciates the opportunity to review and comment on
this draft report.
The report identifies research on the extent and impact of elder
abuse, the challenges to preventing and responding to this complex
problem, and the current federal leadership, activities, and funding
that is dedicated to this issue. At the conclusion of its analysis,
GAO makes a series of recommendations that highlight the role that
stronger federal leadership could have on improving efforts to prevent
and respond to elder abuse, neglect, and exploitation.
The report emphasizes characteristics that may place older adults at
risk for victimization”those things that may increase an older adults'
risk of being abused or neglected. However, the report does not really
address any factors that increase risks for carrying out the act of
abuse itself. These actions are labeled perpetration by the Division
of Violence Prevention (DVP) of the National Center for Injury
Prevention and Control (NCIPC), part of the Centers for Disease
Control and Prevention (CDC). The DVP emphasizes the need to pay
attention to risk factors for perpetration as a central way of
promoting primary prevention. Persons who engage in such abuse are
referred to as perpetrators. If one addresses risk factors for being
abused or neglected without addressing risk factors for perpetrating
abuse or neglect, it is likely the effectiveness of minimization
efforts will be limited. Exploring the risk factors for perpetrating
abuse or neglect is essential to providing a context for thinking
about ways to intervene to stop abuse from beginning, continuing or
escalating.
As noted in the report, research on the extent and impact of elder
abuse suggests that it is a widespread, complex problem that has been
associated with significant negative impacts on the health and well-
being of its victims. Despite these findings, there are substantial
gaps in the research that have prevented a thorough understanding of,
among other things, the incidence, prevalence, risk factors, and
health impacts of elder abuse. Without this important information,
adult protective services (APS) programs throughout the nation have
struggled to implement the most effective interventions possible under
increasingly limited resource constraints.
Compounding the problem to establish strong evidence-based
interventions is the difficulty of collecting, maintaining, and
reporting uniform administrative data on elder abuse. As indicated in
the report, APS programs across the nation have varying definitions of
elder abuse that lead to the collection of administrative data that is
largely incomparable at the national level. This prevents any
meaningful tracking of important programmatic trends as well as the
development of evidence-based practices that would greatly increase
the effectiveness of APS interventions.
Consistent with the report's description, the Administration on Aging
(AoA) administers formula-based grants to State Units on Aging (SUAs)
for elder abuse awareness and prevention activities and a
discretionary grant program for the National Center on Elder Abuse
(NCEA), a national resource center dedicated to the prevention of
elder abuse. Responsible for a range of activities focused on both the
prevention and response to elder abuse, neglect, and exploitation,
AoA's formula grant program has empowered community-based efforts
including the development of multidisciplinary teams, the development
and dissemination of public awareness materials, and support for state
and local APS programs. In support of these efforts and others, the
NCEA provides multidisciplinary programmatic guidance, training and
technical assistance, and a compendium of research and best practices
for elder abuse professionals, researchers, policymakers and the
general public.
In addition to these activities, amendments to the OAA in 2006
authorized the Assistant Secretary for Aging (ASA) to designate a
person within AoA to have responsibility for elder abuse prevention
and services including, as indicated in the report, the development of
objectives, priorities, policy, and a long-term plan for: (1)
facilitating the development, implementation, and continuous
improvement of a coordinated, multidisciplinary elder justice system
in the United States; (2) working with states, the Department of
Justice, and other agencies to collect, maintain, and disseminate data
on elder abuse, neglect, and exploitation, to the extent practicable;
and (3) establishing federal guidelines and disseminating best
practices for uniform data collection and reporting by states.
In accordance with these requirements, AoA has taken proactive steps
to work with federal partners within HHS, including the Assistant
Secretary for Planning and Evaluation (ASPE) and the Centers for
Disease Control and Prevention (CDC), to explore the feasibility of a
national data collection system and to begin developing uniform data
elements for public health surveillance on elder abuse. Despite
progress on these fronts, AoA recognizes the importance of balancing
the need for uniform data and best practices with the burden that
reporting requirements would have on APS programs. States have
indicated that mandating a data collection system would pose an undue
burden on them, given the limited resources made available for elder
abuse prevention formula grants (approximately $5 million in FY 2010).
The Department will review GAO's recommendations and explore the
options available to implement them.
[End of section]
Appendix X: GAO Contact and Staff Acknowledgments:
GAO Contact:
Kay E. Brown, (206) 512-7215, brownke@gao.gov:
Staff Acknowledgments:
Clarita Mrena (Assistant Director) and Eve Weisberg (Analyst-in-
Charge) managed all aspects of this assignment. Divya Bali, Jay Liao,
and Nhi Nguyen made significant contributions to this report, in all
aspects of the work. Paul Hobart assisted with the site visits.
Lorraine Ettaro, Michele Fejfar, Justin Fisher, Cathy Hurley, Sonya
Vartivarian, Monique Williams, and Elizabeth Wood provided technical
support with research methodology and data analysis. Ramona Burton,
Kimberley Granger-Heath, Eileen Larence, Jonathan Meyer, Carol Patey,
and Carolyn Yocom provided subject matter expertise. Susan Bernstein
and Kathleen Van Gelder provided writing assistance. Ellery Scott
provided editorial and production assistance. James Bennett provided
graphics assistance. Craig Winslow provided legal counsel.
[End of section]
Selected Bibliography:
Ron Acierno et al., "National Elder Mistreatment Study," A report
funded by the National Institute of Justice, U.S. Department of
Justice (2009).
Ron Acierno et al.; "Prevalence and Correlates of Emotional, Physical,
Sexual, and Financial Abuse and Potential Neglect in the United
States: The National Elder Mistreatment Study," American Journal of
Public Health, vol. 100, no. 2 (2010).
Scott R. Beach et al., "Financial Exploitation and Psychological
Mistreatment among Older Adults: Differences Between African Americans
and Non-African Americans in a Population-Based Survey," The
Gerontologist, 10:1093 (2010).
Scott R. Beach et al., "Risk Factors for Potentially Harmful Informal
Caregiver Behavior," Journal of the American Geriatrics Society, vol.
53, no. 2 (2005).
Bonnie Brandl, et al., Elder Abuse Detection and Intervention: A
Collaborative Approach, 1st ed. (New York, N.Y.: Springer Publishing
Company, LLC, 2007).
Jason Burnett et al., "Social Networks: A Profile of the Elderly who
Self-Neglect," Journal Elder Abuse & Neglect, vol. 18, no. 4 (2006).
U.S. Department of Health and Human Services, "The National Elder
Abuse Incidence Study." Prepared by the National Center on Elder Abuse
at the American Public Human Services Association in Collaboration
with Westat, Inc. (1998).
XinQi Dong et al., "Self-Neglect and Cognitive Function Among
Community-Dwelling Older Persons," International Journal of Geriatric
Psychiatry, vol. 25, no.8 (2010).
XinQi Dong et al., "Elder Self-Neglect and Abuse and Mortality Risk in
a Community-Dwelling Population," Journal of the American Medical
Association, vol. 302, no. 5 (2009).
Carmel Bitondo Dyer et al., "The High Prevalence of Depression and
Dementia in Elder Abuse or Neglect," Journal of the American Geriatric
Society, vol. 48 (2000).
Bonnie S. Fisher and Saundra L. Regan, "The Extent and Frequency of
Abuse in the Lives of Older Women and Their Relationship With Health
Outcomes," The Gerontologist, vol. 46, no. 2 (2006).
Mark. S. Lachs et al., "The Mortality of Elder Mistreatment," Journal
of the American Medical Association, vol. 280, no. 5 (1998).
Mark S. Lachs et al., "Risk Factors for Reported Elder Abuse and
Neglect: A Nine-Year Observational Cohort Study," The Gerontologist,
vol. 37, no 4 (Health Module, 469) (1997).
Edward O. Laumann et al., "Elder Mistreatment in the United States:
Prevalence Estimates From a Nationally Representative Study," Journal
of Gerontology: Social Sciences, vol. 63B, no. 4 (2008).
The MetLife Mature Market Institute et al., "Broken Trust: Elders,
Family, and Finances - A Study on Elder Financial Abuse Prevention,"
March 2009.
National Research Council of the National Academies, Elder
Mistreatment: Abuse, Neglect and Exploitation in an Aging America
(Washington, D.C.: The National Academies Press, 2003).
Brian K. Payne and Randy R. Gainey, "Differentiating Self-Neglect as a
Type of Elder Mistreatment: How Do These Cases Compare to Traditional
Types of Elder Mistreatment?" Journal of Elder Abuse & Neglect, vol.
17, no. 1 (2005).
Karl Pillemer and David Finkelhor, "The Prevalence of Elder Abuse: A
Random Sample Survey," The Gerontologist, vol. 28, no. 1 (1988).
Carla VandeWeerd and Gregory Paveza, "Verbal Mistreatment in Older
Adults: A Look at Persons with Alzheimer's Disease and Their
Caregivers in the State of Florida," Journal of Elder Abuse & Neglect,
vol. 17, no. 4 (2005).
Aileen Wiglesworth et al., "Screening for Abuse and Neglect of People
with Dementia" Journal of the American Geriatrics Society, vol. 58,
no. 3 (2010).
[End of section]
Related GAO Products:
Guardianships: Cases of Financial Exploitation, Neglect, and Abuse of
Seniors. [hyperlink, http://www.gao.gov/products/GAO-10-1046].
Washington, D.C.: September 30, 2010.
Child Welfare: Improving Social Service Program, Training, and
Technical Assistance Information Would Help Address Long-standing
Service-Level and Workforce Challenges. [hyperlink,
http://www.gao.gov/products/GAO-07-75]. Washington, D.C.: October 6,
2006.
Guardianships: Little Progress in Ensuring Protection for
Incapacitated Elderly People. [hyperlink,
http://www.gao.gov/products/GAO-06-1086T]. Washington, D.C.: September
7, 2006.
Guardianships: Collaboration Needed to Protect Incapacitated Elderly
People. [hyperlink, http://www.gao.gov/products/GAO-04-655].
Washington, D.C.: July 13, 2004.
Child Welfare: Most States Are Developing Statewide Information
Systems, but the Reliability of Child Welfare Data Could Be Improved.
[hyperlink, http://www.gao.gov/products/GAO-03-809]. Washington, D.C.:
July 31, 2003.
Child Protective Services: Complex Challenges Require New Strategies.
[hyperlink, http://www.gao.gov/products/GAO/HEHS-97-115]. Washington,
D.C.: July 21, 1997.
Elder Abuse: Effectiveness of Reporting Laws and Other Factors.
[hyperlink, http://www.gao.gov/products/GAO/HRD-91-74]. Washington,
D.C.: April 24, 1991.
[End of section]
Footnotes:
[1] A recent study estimates that the illegal or improper use of an
older adult's funds, property, or assets may have cost victims at
least $2.6 billion in 2008. To obtain this figure, the study reviewed
media reports of elder financial exploitation for a 3-month period in
2008, then annualized this number by multiplying by four, and added an
estimated amount for media reports that did not include a dollar
figure. MetLife Mature Market Institute et al, "Broken Trust: Elders,
Family, and Finances: A Study on Elder Financial Abuse Prevention,"
March 2009.
[2] See appendix I.
[3] According to the National Adult Protective Services Association,
most state APS programs also provide services to "at-risk adults," or
individuals over the age of 18 who meet certain conditions defined in
state statutes.
[4] According to the American Bar Association, in all states, older
adults with capacity have the right to refuse APS intervention. State
courts generally make determinations regarding an older adult's
capacity, generally defined as their mental ability to understand the
nature and effect of their acts. State courts can appoint a guardian
responsible for the older adult's decision making if he or she is
determined to be incapacitated. For recent GAO reports related to
guardianship, see GAO, Guardianships: Cases of Financial Exploitation,
Neglect, and Abuse of Seniors, GAO-10-1046 (Washington, D.C.: Sept.
30, 2010); and Guardianships: Collaboration Needed to Protect
Incapacitated Elderly People, GAO-04-655 (Washington, D.C.: July 13,
2004).
[5] Pub. L. No. 89-73, 79 Stat. 218 (codified as amended at 42 U.S.C.
§§ 3001-3058ff).
[6] Pub. L. No. 111-148, tit. VI, subtit. H, 124 Stat. 119, 782-804
(2010) (to be codified at 42 U.S.C. §§ 1320b-25, 1395i-3a, and 1397j-
1397m-5). The EJA became law as part of the Patient Protection and
Affordable Care Act on March 23, 2010.
[7] The OAA defines elder justice as "efforts to prevent, detect,
treat, intervene in, and respond to elder abuse, neglect, and
exploitation and to protect older individuals with diminished capacity
while maximizing their autonomy; and the recognition of the [older]
individual's rights, including the right to be free of abuse, neglect,
and exploitation." 42 U.S.C. § 3002(17).
[8] See appendix II for more detailed information on the literature
search.
[9] See appendix II for more detailed information about our survey
methodology.
[10] The NCEA is a national resource center dedicated to the
prevention of elder abuse. Funded by the Administration on Aging in
HHS, it is made up of a consortium of grantees that have been selected
since 1985 for periods of 2 to 5 years. Grantees for fiscal years 2007
through 2010 included the National Adult Protective Services
Association, the National Committee for the Prevention of Elder Abuse,
and the University of Delaware.
[11] According to Elder Mistreatment: Abuse, Neglect, and Exploitation
in an Aging America, by the National Research Council, a relationship
of trust is defined as a relationship in which one party is charged
with, or has assumed, the responsibility for caring for or protecting
the interests of the older person, or when there is an expectation of
care or protection.
[12] Under Medicaid/Medicare requirements and most state laws, these
agencies are the primary entity to investigate abuse in licensed
facility settings, according to HHS.
[13] 42 U.S.C. § 3002(35) and 3058g.
[14] Pub. L. 89-73, 79 Stat. 218.
[15] Pub. L. No. 111-148, tit. VI, subtit. H, 124 Stat. 119, 782-804
(2010) (to be codified at 42 U.S.C. §§ 1320b-25, 1395i-3a, and 1397j-
1397m-5).
[16] 42 U.S.C. § 3011. In general, the OAA requires AoA to administer
grant programs to fund state and local initiatives for those 60 years
of age and older, including social services such as meals on wheels,
legal aid, employment programs, research and community development
projects, and training for professionals in the field of aging. AoA
funds these activities primarily through grants to each state through
its state agency on aging.
[17] 42 U.S.C. §§ 3011(e)(2).
[18] § 2042(a)(2) and (b)(4), 124 Stat. 794-96 (to be codified at 42
USC § 1397-m-1(a)(2) and (b)(4)).
[19] § 2042(a)(1)(B), 124 Stat. 794 (to be codified at 42 U.S.C. §
1397m-1(a)(1)(B)).
[20] § 2042(a)(1)(C), 124 Stat. 794 (to be codified at 42 U.S.C. §
1397m-1(a)(1)(C)).
[21] § 2042(a)(1)(D), 124 Stat. 794 (to be codified at 42 U.S.C. §
1397m-1(a)(1)(D)).
[22] § 2042(a)(1)(E), 124 Stat. 794 (to be codified at 42 U.S.C. §
1397m-1(a)(1)(E)).
[23] § 2031, 124 Stat. 790-91 (to be codified at 42 U.S.C. § 1397l).
[24] § 2042(c), 124 Stat. 795 (to be codified at 42 U.S.C. 1397m-1(c)).
[25] §§ 2021 and 2022, 124 Stat. 786-89 (to be codified at 42 U.S.C.
§§ 1397k and 1397k-1).
[26] 42 U.S.C. § 10603(a)(2)(A).
[27] 42 U.S.C. § 3796gg(b).
[28] A study on the prevalence of elder abuse in the state of New York
is currently being conducted by Lifespan of Greater Rochester Inc.,
Weill Cornell Medical College, the New York City Department for the
Aging, and the New York State Office of Children and Family Services,
and is expected to be released in early 2011.
[29] Surveying this group can be challenging because their impairments
may limit the accuracy and amount of information they are able to
provide.
[30] Mark S. Lachs et al., "Risk Factors for Reported Elder Abuse and
Neglect: A Nine-Year Observational Cohort Study," The Gerontologist,
vol. 37, no. 4 (Health Module, 469) (1997).
[31] Karl Pillemer and David Finkelhor, "The Prevalence of Elder
Abuse: A Random Sample Survey," The Gerontologist, vol. 21, no. 1
(1988).
[32] Instrumental activities of daily living are not necessary for
fundamental functioning, but let an individual live independently in
the community.
[33] Scott Beach et al., "Financial Exploitation and Psychological
Mistreatment among Older Adults: Differences Between African Americans
and non-African Americans in a Population-Based Survey," The
Gerontologist, vol. 10, no. 1093 (July 22, 2010).
[34] Scott R. Beach et al, "Risk Factors for Potentially Harmful
Informal Caregiver Behavior," Journal of the American Geriatrics
Society, vol. 53, no. 2 (2005).
[35] Carmel Bitondo Dyer et al., "The High Prevalence of Depression
and Dementia in Elder Abuse and Neglect," Journal of the American
Geriatric Society, vol. 48, pp. 205-208 (2000).
[36] Beach, "Financial Exploitation and Psychological Mistreatment
among Older Adults: Differences Between African Americans and non-
African Americans in a Population-Based Survey."
[37] Carla VandeWeerd and Gregory Paveza, "Verbal Mistreatment of
Older Adults: A Look at Persons with Alzheimer's Disease and their
Caregivers in the State of Florida," Journal of Elder Abuse and
Neglect, vol. 17, no. 4 (2005).
[38] Ron Acierno, "Prevalence and Correlates of Emotional, Physical,
Sexual, and Financial Abuse and Potential Neglect in the United
States: The National Elder Mistreatment Study," American Journal of
Public Health, vol. 100, no. 2 (2010).
[39] Brian K. Payne and Randy R. Gainey, "Differentiating Self-Neglect
as a Type of Elder Mistreatment: How Do These Cases Compare to
Traditional Types of Elder Mistreatment?" Journal of Elder Abuse and
Neglect, vol. 17, no. 1 (2005).
[40] Ron Acierno, "Prevalence and Correlates of Emotional, Physical,
Sexual, and Financial Abuse and Potential Neglect in the United
States: The National Elder Mistreatment Study."
[41] XinQi Dong et al., "Self-Neglect and Cognitive Function Among
Community-Dwelling Older Persons" International Journal of Geriatric
Psychiatry, vol. 25, no. 8 (2010).
[42] Lachs, "Risk Factors for Reported Elder Abuse and Neglect: A 9-
Year Observational Cohort Study."
[43] Dyer, "The High Prevalence of Depression and Dementia in Elder
Abuse and Neglect."
[44] Researchers recruited a convenience sample of caregiver-care
recipient pairs from patients of University of California Irvine (UCI)
physicians, dementia research participants at UCI, caregivers
contacting the local Alzheimer's Association chapter, clients
attending an adult day care center, and through print media.
[45] Aileen Wiglesworth et al., "Screening for Abuse and Neglect of
People with Dementia" Journal of the American Geriatrics Society, vol.
58, no. 3 (March, 2010).
[46] U.S. Department of Justice, "National Elder Mistreatment Study,"
Doc. Number 226456, March 2009. Overall results later reported in 2010
by Ron Acierno in, "Prevalence and Correlates of Emotional, Physical,
Sexual, and Financial Abuse and Potential Neglect in the United
States: The National Elder Mistreatment Study."
[47] Jason Burnett et al., "Social Networks: A Profile of the Elderly
Who Self-Neglect," Journal of Elder Abuse and Neglect, vol. 18 (2006).
[48] National Center on Elder Abuse, "Domestic Abuse in Later Life:
Abusers" (2005).
[49] U.S. Department of Justice, "National Elder Mistreatment Study,"
Doc. Number 226456, March 2009. Overall results later reported in 2010
by Ron Acierno in, "Prevalence and Correlates of Emotional, Physical,
Sexual, and Financial Abuse and Potential Neglect in the United
States: The National Elder Mistreatment Study."
[50] Subjects were asked about any abuse they had experienced since
age 55.
[51] Bonnie S. Fisher and Saundra L. Regan, "The Extent and Frequency
of Abuse in the Lives of Older Women and Their Relationship with
Health Outcomes," The Gerontologist, vol. 46, no. 2 (2006).
[52] This percentage does not include individuals identified as self-
neglecters.
[53] Mark. S. Lachs et al., "The Mortality of Elder Mistreatment,"
Journal of the American Medical Association, vol. 280, no. 5 (1998).
[54] XinQi Dong et al., "Elder Self-Neglect and Abuse and Mortality
Risk in a Community-dwelling Population," Journal of the American
Medical Association; vol. 302, no. 5 (2009).
[55] This study did not control for perpetrator characteristics.
[56] Appendix III provides elder abuse reporting requirements as
reported by states.
[57] Appendix IV provides APS program characteristics by state.
[58] Massachusetts did not provide a response to this question in our
survey, and South Carolina reported its APS program was administered
in some other way.
[59] According to a national elder abuse organization, at-risk adults
over age 18 as well as older adults are served by the same protective
services agency in most states, while in at least 6 states older
adults are served by a separate agency.
[60] Appendix V provides selected APS eligibility criteria in cases of
alleged elder abuse by state.
[61] The data from Virginia and Florida include reports of all adult
abuse, including older adults.
[62] We did not independently verify the reliability of these data.
[63] The time periods for each fiscal year can vary by state.
[64] Appendix VI provides more detailed information on APS reports,
investigations, and substantiations by state in fiscal year 2009.
[65] APS elder abuse investigation rates were calculated based on the
number of elder abuse investigations reported in the survey of APS
programs and the 2008 U.S. Census Bureau estimated older adult
population [hyperlink,
http://www.census.gov/population/www/projections/projectionsagesex.html]
The 2008 APS estimated elder investigation rates were applied to U.S.
Census Bureau elder population projections for 2020 and 2030,
respectively, to obtain increases in elder abuse investigations that
are based on population growth [hyperlink,
http://www.census.gov/population/www/projections/projectionsagesex.html]
[66] The term "several" refers to three or more program officials
and/or subject matter experts.
[67] Twenty-two states were unable to provide complete funding
information for their APS programs by source in fiscal year 2009.
Thus, we were unable to determine the proportion of nonfederal versus
federal funding for these states. Appendix VII provides detailed
information on the sources of APS budgets by state in fiscal year 2009.
[68] HHS's Administration for Children and Families distributes SSBG
funds by statute to states in proportion to each state's population to
provide social services best suited to the needs of its residents.
These services may include, but are not limited to, daycare and
protective services for children or adults, special services to
persons with disabilities, adoption, case management, health-related
services, transportation, foster care for children or adults,
substance abuse, housing, home-delivered meals,
independent/transitional living, employment services, or any other
social services found necessary by the state. 42 U.S.C. §§1397-1397f.
[69] Hiring freezes and furloughs are also likely a consequence of the
overall economic climate, so may pose a challenge for many programs
statewide.
[70] An official from the national APS trade association told us that
generally good outcomes for APS cases would ensure that any abuse
ceases and that victims' physical and emotional well-being are
preserved. However, there is a lack of clarity and agreement in the
elder abuse field about what constitutes ideal outcomes for various
types of abuse cases.
[71] The Child Abuse Prevention and Treatment Act, originally enacted
in 1974, provides funding to state Child Protective Services programs
responsible for identifying, investigating, and resolving cases of
child abuse, neglect, and exploitation. Pub. L. No. 93-247, 88 Stat. 4
(1974) (codified as amended at 42 U.S.C. §§ 5101-5106i).
[72] In an October 2006 report, we reviewed the extent to which
technical assistance provided by HHS national resource centers was
helpful to states in implementing their federal child welfare
requirements. Nearly all states reported that the federal technical
assistance they received to improve their child welfare programs was
helpful to some degree, although some resources were given higher
ratings than others. GAO, Child Welfare: Improving Social Service
Program, Training, and Technical Assistance Information Would Help
Address Long-Standing Service-Level and Workforce Challenges,
[hyperlink, http://www.gao.gov/products/GAO-07-75] (Washington, D.C.:
Oct. 6, 2006).
[73] Bonnie Brandl, Carmel Bitondo Dyer, Candace J. Heisler, Joanne
Marlatt Otto, Lori A. Stiegel, and Randolph W. Thomas, Elder Abuse
Detection and Intervention: A Collaborative Approach, 1st ed. (New
York, N.Y.: Springer Publishing Company, LLC, 2007).
[74] Federal elder justice activities can target elder abuse, as well
as health care fraud, consumer fraud, and civil rights violations
against older adults. This report provides information on activities
specifically related to elder abuse.
[75] APS also competes with the broad range of other state programs
for SSBG funds received under Title XX of the Social Security Act, but
SSBG is generally not viewed as an elder justice program.
[76] While by all accounts OAA formula grants are the sole source of
funds for elder justice activities directly available to APS, we did
not perform exhaustive legal research to determine if there are any
circumstances under which any other elder justice activities could
ever result in funds going directly to APS.
[77] Each state's grant amount is based on the number of individuals
in a state who are 60 or older. 42 U.S.C. § 3024(a)(1).
[78] Legislative authorizations permit funds to be appropriated, up to
the amount of the authorization, for the purpose specified in the
relevant law. To date, no funds have been appropriated under the EJA,
although the President's fiscal year 2012 budget includes $16.5
million for state APS demonstration projects in detecting or
preventing elder abuse. Elder justice advocates with whom we spoke
considered the new authorizations a significant breakthrough
notwithstanding that no funds have as yet been appropriated because it
raises the potential for funds under Title XX of the Social Security
Act to be made available exclusively for elder justice activities.
[79] Medicaid funds can be used by states for costs such as personal
care services and targeted case management. In addition, the Social
Security Act authorizes HHS to provide "Medicaid waivers" to states
that apply to allow them to spend federal Medicaid dollars on home-and
community-based services not traditionally covered under the Medicaid
program. 42 U.S.C. § 1396n(d).
[80] In fiscal year 2009, total SSBG funding to states was $1.7
billion. This amount does not include specific earmarks or
supplemental grants, such as for disasters.
[81] In fiscal year 2009, total Medicaid funding was $215.6 billion.
See apps. VII and VIII for detailed information on the sources of APS
funding by state in fiscal year 2009.
[82] The Centers for Disease Control and Prevention, AoA, and the
National Institute of Justice have all emphasized the importance of
using the best available evidence to develop a more effective response
to elder abuse.
[83] 42 U.S.C. § 3011(e)(2)(A)(iii) and (iv).
[84] The results of this work are expected to be released in spring
2011.
[85] AoA also provided information to HHS's Office of the Assistant
Secretary for Planning and Evaluation for its recently published
report on the feasibility of establishing a nationwide system for
compiling uniform APS data on elder abuse cases. The report provided
several aspects to consider when creating such a system and noted ways
to strengthen existing APS data systems. Office of the Assistant
Secretary for Planning and Evaluation, Congressional Report on the
Feasibility of Establishing a Uniform National Database on Elder Abuse
(Washington, D.C., March 2010).
[86] States report these data to the federal government, to the extent
practicable, in order to receive the Child Abuse Prevention and
Treatment Act Basic State Grant, which is available to all states for
improving Child Protective Services systems.
[87] § 2042(b)(5), 124 Stat. 795 (to be codified at § 1397m-1(b)(5)).
[88] American Bar Association, Elder Abuse Fatality Review Teams: A
Replication Manual (Washington, D.C., 2005).
[89] 42 U.S.C. § 3011(e)(2)(A)(ii).
[90] Justice's Civil Division recently funded a grant with AoA and the
Office of the Assistant Secretary for Planning and Evaluation at HHS
to identify and prioritize elder justice policy, practice, and
research issues and develop recommendations to the government to
address those issues. This effort is expected to be completed by
January 2012.
[91] National Research Council of the National Academies, Elder
Mistreatment: Abuse, Neglect and Exploitation in an Aging America,
2003.
[92] 42 U.S.C. § 3011(e)(2)(A)(ii).
[93] The official noted that AoA would have liked to expand its elder
justice efforts further, such as in supporting law enforcement at the
state and local level, if it did not have such limitations.
[94] According to AoA officials, this is an ad hoc group of federal
employees that meets once or twice a year, but has no formal structure
or charge. They also noted that because this is an ad hoc group, there
is no documentation of the group's meetings.
[95] Such research could help provide a foundation for ongoing
surveillance of elder abuse.
[96] National incidence studies have been mandated periodically since
1974 in the field of child welfare to measure the extent of child
abuse over time. According to HHS, results of studies published in
1980, 1987, 1996 and 2010 have helped to highlight areas of
underreporting and deepen program officials' knowledge of child abuse
patterns.
[97] § 2021, 124 Stat. 786-87 (to be codified at 42 U.S.C. § 1397k).
[98] § 2022, 124 Stat. 787-89 (to be codified at 42 U.S.C. § 1397k-1).
[99] § 2042(b), 124 Stat. 794-95 (to be codified at 42 U.S.C. § 1397m-
1(b)).
[100] 2042(b)(4), 124 Stat. 795 (to be codified at 42 U.S.C. § 1397m-
1(b)(4)).
[101] 42 U.S.C. § 3011(e)(2).
[End of section]
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