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United States Government Accountability Office: 
GAO: 

Report to Congressional Requesters: 

July 2013: 

Elder Justice: 

More Federal Coordination and Public Awareness Needed: 

GAO-13-498: 

GAO Highlights: 

Highlights of GAO-13-498, a report to congressional requesters. 

Why GAO Did This Study: 

As the percentage of older adults in the population increases, the 
number of older adults at risk of abuse also is growing. At the same 
time, constraints on public funds may limit assistance to the growing 
population of older adults in need. GAO was asked to review elder 
justice program issues. This report addresses: (1) the extent to which
there is fragmentation, overlap, or duplication across the federal grant
programs that support elder justice; (2) the extent to which federal
programs coordinate their efforts and monitor elder justice outcomes; 
and (3) how state aging agencies, area agencies on aging, and service 
providers deliver federal elder justice services and what challenges, 
if any, they face in doing so. GAO reviewed relevant federal laws and
regulations, identified federal elder justice programs, surveyed federal
officials about program elements, reviewed program documentation, and 
visited agencies responsible for elder justice in Illinois, Virginia and
Arizona. GAO selected states based on the percentage of the elderly in 
the state population, geographic dispersion, and percentage of the
state’s Older American Act funds devoted to elder care. 

What GAO Found: 

In fiscal year 2011, two agencies-—the Departments of Health and Human
Services (HHS) and Justice (Justice)-—separately administered 12 
fragmented but minimally overlapping programs that directed funds 
toward elder justice, with low risk of duplication. Specifically, 
because more than one federal agency administers these programs, GAO 
found that these grant programs are fragmented. Further, GAO found 
that overlap across the 12 programs was minimal because the programs 
varied with respect to (1) funding mechanisms and recipients, (2) 
elder abuse victims targeted, (3) service providers, and (4) 
activities conducted. For example, a few of these programs provided 
formula grants to all states and most dispersed discretionary grants 
to a limited number of recipients. Programs that supported victims of 
elder abuse generally assisted all types of victims, but some also 
focused on certain subgroups, such as older women. Some programs that 
assisted service providers also targeted specific subgroups, such as 
judges and court personnel. In addition, elder justice programs 
supported a wide range of activities. For example, one HHS program
provided public education to help identify and prevent elder abuse, 
while a Justice program trained law enforcement officers to 
investigate instances of elder abuse. Considering the variation across 
funding mechanisms and recipients, the elder abuse victims and service 
providers targeted by the grants, and the types of activities 
conducted, overlap across the 12 programs is minimal and the risk of
duplication—-when two or more agencies or programs are engaged in the 
same activities or provide the same services to the same 
beneficiaries—-is low. 

We have previously reported that coordination is key to ensuring the 
efficient use of limited resources to address issues that cut across 
more than one agency. While federal coordination is in development—-
for example, HHS, Justice, and other agencies recently formed the 
Elder Justice Coordinating Council—-federal agencies have yet to 
articulate common objectives and outcomes as precursors to future 
measures for elder justice programs, which would provide a rationale for
coordination. Further, few federal programs tracked elder justice 
outcomes in 2011 or conducted program evaluations to assess 
effectiveness, making it difficult to determine what impact, if any, 
many programs have on victims of elder abuse. 

Officials representing state aging agencies, area agencies on aging 
and service providers in the three states GAO visited identified the 
increased demand for elder justice services in a constrained fiscal 
environment as a major challenge in meeting the needs of the growing 
older adult population. Officials also cited the need for greater 
awareness of elder abuse by the public and training of direct service 
providers who interact with older adults on a regular basis, to help
prevent elder abuse or recognize its symptoms. Five of the nine 
regional agency officials GAO spoke with said elder justice issues 
need to be elevated to national attention for the general public by a 
national public awareness campaign. The Elder Justice Coordinating 
Council is considering a recommendation to sponsor a national campaign 
but has not yet done so. 

What GAO Recommends: 

GAO recommends that HHS take the lead in identifying common objectives 
and outcomes for the federal elder justice effort and that HHS and 
Justice develop a national elder justice public awareness campaign. 
HHS concurred and Justice did not comment. 

View [hyperlink, http://www.gao.gov/products/GAO-13-498]. For more 
information, contact Kay Brown at (202) 512-7215 or brownke@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

Federal Elder Justice Programs Are Fragmented but Minimally 
Overlapping, Reducing the Risk for Duplication: 

Federal Coordination of Elder Justice Activities Is in Development, 
but Monitoring Is Limited: 

Challenges Persist in Serving Older Adults and Stakeholders Identified 
a Need for Additional Training and Awareness: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Scope and Methodology for Surveying Federal Elder Justice 
Program Managers: 

Appendix II: Federal Elder Justice Programs: 

Appendix III: Comments from the U.S. Department of Health and Human 
Services: 

Appendix IV: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Federal Programs That Directed All or Some Funds toward Elder 
Justice in Fiscal Year 2011: 

Table 2: Variation in Types of Victims Targeted under Federal Elder 
Justice Programs: 

Table 3: Variation in Types of Service Providers Supported by Federal 
Elder Justice Programs: 

Table 4: Variation in Activities Supported by Federal Programs that 
Directed Funds toward Elder Justice: 

Table 5: Strategic Goals and Objectives under HHS and Justice That May 
Address Elder Justice: 

Table 6: Federal Programs That Directed All Funds toward Elder Justice 
(ranked by Fiscal Year 2011 obligations): 

Table 7: Federal Programs that Directed Some Funds toward Elder 
Justice (ranked by FY2011 obligations): 

Table 8: Federal Programs with Elder Justice as a Program Component or 
Allowable Activity (Listed by Agency in Alphabetical Order): 

Figures: 

Figure 1: Agencies and Other Individuals Positioned to Support Elder 
Justice Efforts: 

Figure 2: Formula Grant and Discretionary Grant Elder Justice Funding: 

Figure 3: Number of Federal Elder Justice Programs and Administering 
Departments and Agencies: 

Figure 4: Elder Justice Program Selection Criteria: 

Abbreviations: 

ACL: Administration for Community Living: 

Advisory Board: Advisory Board on Elder Abuse: 

AoA: Administration on Aging: 

APS: Adult protective services: 

CFPB: Bureau of Consumer Financial Protection (commonly referred to as 
the Consumer Financial Protection Bureau): 

Council: Elder Justice Coordinating Council: 

Working Group: Elder Justice Interagency Working Group: 

HHS: Department of Health and Human Services: 

HUD: Department of Housing and Urban Development: 

Justice: Department of Justice: 

EJA: Elder Justice Act of 2009: 

EJCC: Elder Justice Coordinating Council: 

FTC: Federal Trade Commission: 

FinCEN: Financial Crimes Enforcement Network: 

NCEA: National Center on Elder Abuse: 

Office for Older Americans: Office for the Financial Protection of 
Older Americans: 

OAA: Older Americans Act of 1965: 

SEC: Securities and Exchange Commission: 

Treasury: Department of the Treasury: 

VAWA: Violence Against Women Act of 1994: 

[End of section] 

GAO:
United States Government Accountability Office: 
441 G St. N.W. 
Washington, DC 20548: 

July 10, 2013: 

The Honorable Lamar Alexander: 
Ranking Member: 
Committee on Health, Education, Labor and Pensions: 
United States Senate: 

The Honorable Michael B. Enzi: 
Ranking Member: 
Subcommittee on Children and Families: 
Committee on Health, Education, Labor and Pensions: 
United States Senate: 

The Honorable Bob Corker: 
United States Senate: 

Elder justice programs are designed to address the occurrence of elder 
abuse in American society and focus primarily on the prevention, 
identification, and response to elder abuse. At the same time that 
older adults comprise an increasing proportion of the nation's 
population, programs that provide assistance to this population may 
face fiscal constraints at the federal, state, and local level. We 
recently reported that federal leadership in the elder justice area is 
lacking and that a national strategy to address challenges related to 
elder financial exploitation in particular is needed.[Footnote 1] 
These conditions and the expected growth in the number of older adults 
who may be at risk of abuse have raised questions in the Congress 
about the number and structure of federal programs with elder justice 
activities. You asked us to review federal elder justice program 
management issues. This report addresses (1) the extent to which there 
is fragmentation across the federal grant programs that support elder 
justice and the extent to which these grant programs overlap or 
support duplicative services; (2) the extent to which federal programs 
coordinate their efforts and monitor elder justice outcomes; and (3) 
how state aging agencies, area agencies on aging and service providers 
deliver federal elder justice services and what challenges, if any, 
they face in doing so. 

Using the framework established in our prior work addressing 
fragmentation, overlap, and duplication, in this report we use the 
following definitions for analysis of elder justice programs: 

* Fragmentation: when more than one federal agency (or more than one 
organization within an agency) is involved in the same broad area of 
national interest. 

* Overlap: when programs have similar goals, devise similar strategies 
and activities to achieve those goals, or target similar users. 
Overlap may result from statutory or other limitations beyond an 
agency's control. 

* Duplication: when two or more agencies or programs are engaged in 
the same activities or provide the same services to the same 
beneficiaries.[Footnote 2] 

To examine the extent to which fragmentation exists across the federal 
grant programs that support elder justice and the extent to which 
these grant programs overlap or support duplicative services, we 
developed an initial list of programs in federal agencies that met our 
definition of elder justice and one of three selection criteria: (1) 
programs that directed all funds toward elder justice activities; (2) 
programs that directed some funds toward elder justice activities, or 
(3) programs that supported elder justice as an allowable activity. 
[Footnote 3] The third criterion pertains to programs that have a 
broader focus and target population than do elder justice programs, 
but may have some activities that relate to elder abuse, neglect or 
exploitation. In addition, programs had to have incurred obligations 
in fiscal year 2011 to be included in the list. Next, we surveyed 
federal agency officials to collect descriptive information about 
elder justice programs that met one of our first two selection 
criteria, or were determined to potentially meet one of those criteria 
but required additional information. The survey collected information 
on key program elements, including objectives, activities, target 
populations, outcome measures, and obligations during fiscal year 
2011. The survey response rate was 100 percent. The survey also 
allowed us to confirm, exclude, and add programs based on 
consultations with agency officials. As a result of our analysis of 
the survey data and follow-up contact with agency officials, we 
identified 12 programs that met one of the first two selection 
criteria and funded elder justice activities in fiscal year 2011. We 
analyzed whether similarities and differences in key program elements 
indicated potential fragmentation, overlap, or duplication, and 
whether program officials monitored program outcomes. Appendix I 
provides a detailed description of our methodology for the survey and 
its limitations, as well as its scope. 

To determine the extent to which federal programs coordinate their 
efforts and monitor elder justice outcomes, our survey collected 
information on federal elder justice programs' coordination, 
monitoring, and program evaluation. We conducted written follow-up 
with program officials about their efforts, reviewed their planning 
documents, and assessed this information to identify elder justice 
programs' monitoring and coordination efforts. 

To determine how state aging agencies, area agencies on aging and 
service providers deliver federal elder justice services and what 
challenges, if any, they face in doing so, we conducted site visits to 
Arizona, Illinois, and Virginia. We selected these states because a 
relatively high percentage of the state population is over 60 years of 
age; geographic dispersion; and a relatively high percentage of Older 
Americans Act of 1965 funding in the state's budget is devoted to 
elder care.[Footnote 4] In each state, we interviewed staff from the 
state aging agency, and three area aging agencies, and in one state, 
officials from two local service providers, about challenges in 
delivering elder justice services. We also interviewed experts in the 
field of aging and elder abuse including representatives of the 
American Bar Association-Commission on Law and Aging, the National 
Health Policy Forum, the National Association of States United for 
Aging and Disabilities, and the Woodrow Wilson International Center 
for Scholars. Findings from these site visits are not generalizable to 
all aging agencies or service providers, but provide important 
insights. 

We conducted this performance audit from March 2012 to July 2013 in 
accordance with generally accepted government auditing standards. 
Those 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 the audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives: 

Background: 

Elder justice can be defined as efforts to prevent, identify, and 
respond to elder abuse. The following are examples of the types of 
objectives federal elder justice programs may include: 

* Preventing and identifying elder abuse, such as conducting outreach 
and public education and investigating allegations of elder abuse. 

* Responding to elder abuse, such as providing counseling, prosecuting 
elder abuse cases, advocating on behalf of nursing home residents, and 
offering legal assistance. 

* Providing training and technical assistance related to elder abuse 
for individuals and agencies. 

* Conducting research related to elder abuse issues, such as the 
development of information and data systems and identifying the 
incidence. 

Federal Elder Justice Program Structure: 

Federal elder justice programs are administered and funded through a 
complex intergovernmental structure. The Older Americans Act of 1965 
(OAA) established the Administration on Aging (AoA) within the 
Department of Health and Human Services (HHS) as the chief federal 
advocate for older Americans[Footnote 5] and assigned responsibility 
for elder abuse prevention to the AoA. In April 2012, HHS established 
the Administration for Community Living (ACL), which brought together 
the AoA, the Office on Disability and the Administration on 
Developmental Disabilities to better align the federal programs that 
address the community living service and support needs of both the 
aging and disability populations, among other things. 

Elder justice programs funded by HHS are implemented through the aging 
services network.[Footnote 6] Authorized by the OAA, the aging 
services network was developed to help people age 60 and over maintain 
maximum independence in their homes and communities and to promote a 
continuum of care for vulnerable older adults. The aging services 
network is now made up of 56 state aging agencies, 629 area agencies 
on aging (AAAs), and almost 20,000 service provider organizations, 
many of which rely on volunteers, that deliver services to older 
adults.[Footnote 7] Further, the OAA authorizes grants administered by 
the AoA, within ACL, to fund initiatives for those 60 years of age and 
older throughout the aging services network, including social services 
such as home-delivered meals, legal assistance, employment programs, 
research and community development projects, and training for 
professionals in the field of aging.[Footnote 8] Elder justice 
programs supported by the Department of Justice (Justice) also are 
delivered through the aging services network as well as through other 
state agencies, local social service and government agencies, and 
tribal government agencies. 

In order to be able to participate in OAA grants to states, the 
statute required states to establish AAAs to advocate for, plan, and 
coordinate programs for older persons, including elder justice 
programs.[Footnote 9] AAAs provide services such as making elder abuse 
prevention presentations to local, and state organizations, training 
bank clerks and field workers such as sanitation, water department and 
utility employees to identify potential victims of elder abuse, and 
providing legal services. According to a report by the National Health 
Policy Forum, approximately 42 percent of AAAs are non-profit 
agencies, about 30 percent are part of city or county governments, and 
about 23 percent are part of councils of government or regional 
planning and development agencies.[Footnote 10] The rest are located 
in colleges, community action agencies and other organizations. 

State Adult Protective Services (APS) programs also provide services 
to abused, neglected or exploited older adults and adults with 
disabilities. The abuse can be physical, psychological, or sexual, and 
the exploitation can involve either financial or material possessions. 
Neglect can be inattention by a caregiver or the inability of an 
individual to care for themselves. APS programs are primarily the 
responsibility of states and APS programs vary greatly with regard to 
the age ranges they serve, and how cases are handled. States tend to 
fund APS programs through multiple funding sources, including the 
federal Social Services Block Grant.[Footnote 11] 

States are primarily responsible for protecting older adults from 
abuse. However, the OAA and a number of other federal laws include 
provisions that can address elder justice in support of state and 
local efforts, including the following: 

* The Elder Justice Act of 2009 recognizes an older adult's rights and 
his or her ability to be free of abuse, neglect, and exploitation. 
[Footnote 12] The Act includes provisions to address some of the 
limitations of federal and state efforts to prevent and respond to 
abuse, neglect, and exploitation of older adults, including a new 
state formula grant program under Title XX of the Social Security Act 
for adult protective services, requirements for reporting crimes in 
long-term care facilities, and the development of advisory bodies on 
elder abuse. 

* The Tax Relief and Health Care Act of 2006[Footnote 13] authorizes 
HHS to study the feasibility of establishing a uniform national 
database on elder abuse. Even though funding for the data base has not 
been authorized, HHS completed the feasibility study in March 2010.The 
study recommended three options for constructing a national data base 
on elder abuse from existing administrative data collection systems. 

* The Victims of Trafficking and Violence Protection Act of 2000, 
[Footnote 14] which amended the Violence Against Women Act of 1994 
(VAWA),[Footnote 15] authorized several domestic violence programs, 
including training for prosecutors and other relevant court officers 
about dealing with elder abuse, neglect, and exploitation.The Violence 
Against Women and Department of Justice Reauthorization Act of 
2005[Footnote 16] amended VAWA to authorize grants for programs to 
assist victims of elder abuse, neglect, and exploitation, aged 50 and 
older. The activities funded included training programs for law 
enforcement, prosecutors, government agency officials, victim 
assistants, and others in recognizing and addressing elder abuse and 
exploitation; providing services for victims of violence; supporting 
collaborative community responses to victims; and conducting cross-
training for victim service organizations. The VAWA was reauthorized 
in February 2013.[Footnote 17] 

The focus of HHS's elder justice programs is on social services for 
older adults, and Justice supports elder justice programs and 
activities that include civil and criminal prosecutions of elder abuse 
and neglect as well as health care fraud cases. Justice also helps 
fund state and local efforts to reduce and prevent victimization of 
older individuals and to support services for older victims. These 
efforts address several types of abuse, and exploitation, including 
domestic violence, sexual assault, and consumer fraud. Several other 
federal agencies, including the Federal Trade Commission, the 
Department of Housing and Urban Development, the Securities and 
Exchange Commission, and the Consumer Financial Protection Bureau 
(CFPB) also provide support for elder justice programs in areas 
related to financial and consumer protection.[Footnote 18] Combating 
elder financial abuse is explicitly included in the mission of the 
CFPB's recently established Office of Financial Protection for Older 
Americans.[Footnote 19] Figure 1 shows the federal, state, regional 
and local service agencies that support and deliver elder justice 
efforts. 

Figure 1: Agencies and Other Individuals Positioned to Support Elder 
Justice Efforts[A]: 

[Refer to PDF for image: illustration: concentric circles] 

Victims of elder abuse: 

Consumer protection: 
Local level: 
* Bank tellers; 
* Letter carriers; 
* Service workers (i.e. utility technicians). 
State level: 
* State insurance, banking, and securities regulators; 
Federal level: 
* Consumer Financial Protection Bureau; 
* Department of the Treasury; 
* Securities and Exchange Commission; 
* Federal Trade Commission. 

Social services: 
Local level: 
* Multi-service organizations[B]; 
* Area agencies on aging; 
* Legal assistance groups; 
State level: 
* State units on aging; 
* Adult Protective Services; 
Federal level: 
* Department of Health and Human Services. 

Criminal justice: 
Local level: 
* Local law enforcement agencies; 
* District Attorneys’ offices; 
* Local courts; 
* Social Service agencies[E]; 
State level: 
* State law enforcement agencies; 
* State Attorneys General[C]; 
* State courts; 
Federal level: 
* Department of Justice[D]. 

Source: GAO analysis of information provided by agencies. 

[A] The relationship between the federal and the state and local 
agencies in a given system varies. 

[B] Multiservice organizations are organizations that deliver more 
than one type of public benefit program, such as congregate meals, 
Supplemental Nutrition Assistance Program cards, and legal assistance. 

[C] State attorneys general may also play a consumer protection role. 

[D] Justice also plays a consumer protection role. 

[E] Social service agencies include domestic violence and sexual 
assault victim services providers. 

[End of figure] 

Elder Justice Funding: 

HHS and Justice fund elder justice programs through formula grants and 
discretionary grants to agencies as well as tribal and non-profit 
organizations in each state. For programs that deliver funds through 
grants, the state agencies submit applications or agree to meet 
certain requirements with information provided by regional or local 
agencies, which may provide the services themselves or contract with 
independent providers to deliver the services. Some HHS and Justice 
programs are funded through discretionary grants, which may be awarded 
directly to any eligible applicant that meets eligibility criteria. 
Eligible applicants for HHS and Justice elder justice discretionary 
grant programs may include area agencies on aging, multi-service 
organizations, district attorneys' offices, legal assistance groups 
and postsecondary institutions.[Footnote 20] Figure 2 illustrates the 
flow of funding for elder justice programs from HHS and Justice to 
several types of grant recipients. 

Figure 2: Formula Grant and Discretionary Grant Elder Justice Funding: 

[Refer to PDF for image: illustrated flow chart] 

Federal funding: to: 

Health and Human Services; 
Formula grants; and Block grants; to: 
State agency on aging. 

Discretionary grants; 
to: 
National nonprofit groups; 
Postsecondary institutions. 

State agency on aging: to: 
Area agencies on aging: to: 
Local service providers.         

Federal funding: to: 

Department of Justice: 
Formula grants; Discretionary grants; to: 

Other state agencies: to: 
Local government agencies; 
Tribal organizations (discretionary only); to: 

Local service providers. 
                        
Source: GAO analysis of survey data and program documentation. 

[A] HHS and Justice administer elder justice programs that did not 
award grants but rather used funds to conduct activities and 
administered contracts and interagency agreements as appropriate. 

[End of figure] 

Federal Elder Justice Programs Are Fragmented but Minimally 
Overlapping, Reducing the Risk for Duplication: 

Federal Elder Justice Programs Are Administered by Multiple Agencies: 

In fiscal year 2011, HHS and Justice administered 12 programs that 
directed federal funds toward elder justice programs. Seven of these 
programs directed all funds toward elder justice in fiscal year 2011; 
the other five directed some of their funds toward elder justice but 
supported activities for other purposes, as well. Table 1 lists the 12 
programs that directed funds toward elder justice. The fiscal year 
2011 obligations reported in table 1 include federal funds only. 

Table 1: Federal Programs That Directed All or Some Funds toward Elder 
Justice in Fiscal Year 2011: 

Health and Human Services programs: 

Program: Prevention of Elder Abuse, Neglect, and Exploitation; 
Directed all funds toward elder justice: [Check]; 
Directed some funds toward elder justice: [Empty]; 
Fiscal year 2011 federal obligations: $5,033,000. 

Program: Long-Term Care (LTC) Ombudsman Program; 
Directed all funds toward elder justice: [Empty]; 
Directed some funds toward elder justice: [Check]; 
Fiscal year 2011 federal obligations: [A]. 

Program: National Center on Elder Abuse; 
Directed all funds toward elder justice: [Check]; 
Directed some funds toward elder justice: [Empty]; 
Fiscal year 2011 federal obligations: $804,000. 

Program: National Adult Protective Services (APS) Resource Center[B]; 
Directed all funds toward elder justice: [Check]; 
Directed some funds toward elder justice: [Empty]; 
Fiscal year 2011 federal obligations: $200,000. 

Program: National Long-Term Care Ombudsman Resource Center; 
Directed all funds toward elder justice: [Empty]; 
Directed some funds toward elder justice: [Check]; 
Fiscal year 2011 federal obligations: [A]. 

Program: National Institute on Aging (NIA) Research Activities Related 
to Elder Mistreatment; 
Directed all funds toward elder justice: [Check]; 
Directed some funds toward elder justice: [Empty]; 
Fiscal year 2011 federal obligations: $1,134,000. 

Program: Interpersonal Violence within Families and Among 
Acquaintances Prevention; 
Directed all funds toward elder justice: [Empty]; 
Directed some funds toward elder justice: [Check]; 
Fiscal year 2011 federal obligations: [A]. 

Justice programs: 

Program: Services, Training, Officers, and Prosecutors (STOP) Violence 
Against Women Formula Grant Program; 
Directed all funds toward elder justice: [Empty]; 
Directed some funds toward elder justice: [Check]; 
Fiscal year 2011 federal obligations: [A]. 

Program: Enhanced Training and Services to End Violence Against and 
Abuse of Women Later in Life Program; 
Directed all funds toward elder justice: [Check]; 
Directed some funds toward elder justice: [Empty]; 
Fiscal year 2011 federal obligations: $5,249,000. 

Program: Coordinated Tribal Assistance Solicitations: Tribal Elder 
Outreach Program; 
Directed all funds toward elder justice: [Check]; 
Directed some funds toward elder justice: [Empty]; 
Fiscal year 2011 federal obligations: $1,454,000. 

Program: Grants to Encourage Arrest Policies and Enforcement of 
Protection Orders Program; 
Directed all funds toward elder justice: [Empty]; 
Directed some funds toward elder justice: [Check]; 
Fiscal year 2011 federal obligations: [A]. 

Program: Elder Justice and Nursing Home Initiative; 
Directed all funds toward elder justice: [Check]; 
Directed some funds toward elder justice: [Empty]; 
Fiscal year 2011 federal obligations: $747,000. 

Source: GAO analysis of survey data and agency documents. 

[A] Programs that directed some funds toward elder justice were not 
able to report obligations specifically for elder justice because 
those activities are not tracked separately from overall program 
activities, according to officials. 

[B] The federal government provides technical assistance and support 
to states for APS through this resource center. APS efforts are 
primarily the responsibility of states and there have been no 
significant federal funds provided specifically and solely for APS. 

[End of table] 

Because more than one agency is involved in this same broad area of 
national interest, and the agencies have just begun to coordinate 
their activities, these programs are fragmented. However, the 
administration has begun to take steps to enhance coordination which, 
as we previously reported, can help address some of the problems that 
arise from a fragmented array of programs supporting the same national 
interest.[Footnote 21] 

In addition, we identified 34 other federal programs that supported 
elder justice indirectly--by providing federal funds for elder justice 
as an allowable activity(see figure 3). Because elder justice was an 
allowable activity in these 34 programs, grant recipients determined 
whether elder justice activities would be conducted in a given fiscal 
year.[Footnote 22] As a result, federal program managers could not 
tell us which elder justice activities to compare for that year, to 
determine if overlap or duplication occurred, for those 34 grant 
programs. 

Figure 3: Number of Federal Elder Justice Programs and Administering 
Departments and Agencies: 

[Refer to PDF for image: stacked horizontal bar graph] 

Department of Health and Human Services; 
Number of programs that included elder justice as a component or 
allowable activity: 19; 
Number of programs that directed some funds toward elder justice: 3; 
Number of programs that directed all funds toward elder justice: 4. 

Department of Justice; 
Number of programs that included elder justice as a component or 
allowable activity: 3; 
Number of programs that directed some funds toward elder justice: 2; 
Number of programs that directed all funds toward elder justice: 3. 

Federal Trade Commission; 
Number of programs that included elder justice as a component or 
allowable activity: 3; 
Number of programs that directed some funds toward elder justice: 0; 
Number of programs that directed all funds toward elder justice: 0. 

Department of Housing and Urban Development; 
Number of programs that included elder justice as a component or 
allowable activity: 3; 
Number of programs that directed some funds toward elder justice: 0; 
Number of programs that directed all funds toward elder justice: 0. 

Securities and Exchange Commission; 
Number of programs that included elder justice as a component or 
allowable activity: 5; 
Number of programs that directed some funds toward elder justice: 0; 
Number of programs that directed all funds toward elder justice: 0. 

Department of the Treasury; 
Number of programs that included elder justice as a component or 
allowable activity: 1; 
Number of programs that directed some funds toward elder justice: 0; 
Number of programs that directed all funds toward elder justice: 0. 

Source: GAO analysis of information provided by agency officials. 

[End of figure] 

Overlap and Duplication are Minimal in Federal Elder Justice Effort: 

The 12 programs supported elder justice activities through a variety 
of federal funding mechanisms. Ten of the programs supported the 
federal elder justice effort through grants to a variety of grantees 
such as states, localities, universities, and other grantees, while 
the remaining two programs--HHS' Interpersonal Violence within 
Families and Among Acquaintances Prevention program and Justice's 
Elder Justice and Nursing Home Initiative--did not award grants but 
administered contracts and interagency agreements. Because few of 
these programs provided formula grants to all states and most 
dispersed discretionary grants to limited number of recipients of 
several types, there is minimal overlap in this area. 

Specifically, 3 of the 10 grant programs provided a guaranteed base of 
funding through formula grants to all states; however, each of these 
programs awarded grants to state agencies for different purposes and 
the state agency recipients of the HHS grants differed from the 
recipients of the Justice grant.[Footnote 23] One HHS program awarded 
formula grants to state aging agencies to fund elder justice 
prevention and awareness activities and the other program funded 
assistance to residents of long term care facilities. The Justice 
program awarded formula grants to state criminal justice agencies to 
fund elder justice activities as well as other law enforcement and 
prosecution strategies. Moreover, 7 of the 10 elder justice grant 
programs required recipients to compete for funding by awarding 
discretionary grants to a limited number of grant recipients. Three of 
these discretionary grants provided funding to direct service 
providers, such as local organizations serving domestic and sexual 
assault victims, local governments, or courts. The remaining four 
discretionary grants provided funding to a nonprofit organization and 
a limited number of postsecondary institutions to operate resource 
centers for state and local governments or to conduct research related 
to elder mistreatment. 

Federal elder justice programs also provided support for a variety of 
types of victims and potential victims of elder abuse. Nine of the 12 
programs provided services to victims and potential victims of elder 
abuse: 5 provided assistance to all types of victims and 4 focused on 
key subgroups of victims, further reducing the potential for overlap. 
For example, 1 of the 4 programs served older female victims, another 
targeted victims in long-term care facilities, and still another 
served victims in tribal communities. Table 2 displays the types of 
victims targeted by the federal elder justice programs we identified. 

Table 2: Variation in Types of Victims Targeted under Federal Elder 
Justice Programs: 

Health and Human Services programs: 

Program name: Prevention of Elder Abuse, Neglect, and Exploitation; 
Subgroups of victims: All types of older adult victims: [Check]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Program name: Long-Term Care (LTC) Ombudsman Program; 
Subgroups of victims: All types of older adult victims: [Empty]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Check]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Program name: National Center on Elder Abuse; 
Subgroups of victims: All types of older adult victims: [Check]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Program name: National Adult Protective Services (APS) Resource Center; 
Subgroups of victims: All types of older adult victims: [A]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Program name: National Long-Term Care Ombudsman Resource Center; 
Subgroups of victims: All types of older adult victims: [A]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Program name: National Institute on Aging (NIA) Research Activities 
Related to Elder Mistreatment; 
Subgroups of victims: All types of older adult victims: [A]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Program name: Interpersonal Violence within Families and Among 
Acquaintances Prevention[B]; 
Subgroups of victims: All types of older adult victims: [Check]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Justice programs: 

Program name: Services, Training, Officers, Prosecutors (STOP) 
Violence Against Women Formula Grant Program; 
Subgroups of victims: All types of older adult victims: [Empty]; 
Subgroups of victims: Female victims of all ages[C]: [Check]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Program name: Enhanced Training and Services to End Violence Against 
and Abuse of Women Later in Life Program[D]; 
Subgroups of victims: All types of older adult victims: [Empty]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Check]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Program name: Coordinated Tribal Assistance Solicitations: Tribal 
Elder Outreach Program; 
Subgroups of victims: All types of older adult victims: [Empty]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Check]. 

Program name: Grants to Encourage Arrest Policies and Enforcement of 
Protection Orders Program; 
Subgroups of victims: All types of older adult victims: [Check]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Program name: Elder Justice and Nursing Home Initiative[B]; 
Subgroups of victims: All types of older adult victims: [Check]; 
Subgroups of victims: Female victims of all ages[C]: [Empty]; 
Subgroups of victims: Older female victims[C]: [Empty]; 
Subgroups of victims: Victims in LTC facilities: [Empty]; 
Subgroups of victims: Victims in tribal communities[C]: [Empty]. 

Source: GAO analysis of survey data and agency documents. 

[A] These programs did not directly serve victims or potential victims 
directly, rather they engaged in research on elder abuse in general. 

[B] These programs did not award grants but rather used funds to 
conduct activities and administered contracts and interagency 
agreements as appropriate. 

[C] Subgroup name includes "potential victims." 

[D] Program officials reported that this program also serves some male 
victims. 

[End of table] 

Moreover, a variety of service providers--organizations that deliver 
services at the state and local level--were supported by the 12 elder 
justice programs. In 2011, 8 programs targeted specific subgroups of 
service providers while 4 programs did not target subgroups of service 
providers. Even some of the 4 programs that provided support to all 
types of service providers specialized to some degree. For example, 
one program supported outreach focused on tribal elders while another 
focused on elder mistreatment research (see table 3). 

Table 3: Variation in Types of Service Providers Supported by Federal 
Elder Justice Programs: 

Health and Human Services programs: 

Subgroups of service providers: Prevention of Elder Abuse, Neglect, 
and Exploitation; 
All types of service providers: [Check]; 
Legal and law enforcement professionals: [Empty]; 
Medical/health care professionals: [Empty]; 
State/local APS workers: [Empty]; 
State/local LTC providers: [Empty]; 
LTC facilities workers: [Empty]. 

Subgroups of service providers: Long-Term Care (LTC) Ombudsman Program; 
All types of service providers: [Check]; 
Legal and law enforcement professionals: [Empty]; 
Medical/health care professionals: [Empty]; 
State/local APS workers: [Empty]; 
State/local LTC providers: [Check]; 
LTC facilities workers: [Check]. 

Subgroups of service providers: National Center on Elder Abuse; 
All types of service providers: [Check]; 
Legal and law enforcement professionals: [Empty]; 
Medical/health care professionals: [Empty]; 
State/local APS workers: [Empty]; 
State/local LTC providers: [Empty]; 
LTC facilities workers: [Empty]. 

Subgroups of service providers: National Adult Protective Services 
(APS) Resource Center; 
All types of service providers: [Empty]; 
Legal and law enforcement professionals: [Empty]; 
Medical/health care professionals: [Empty]; 
State/local APS workers: [Check]; 
State/local LTC providers: [Empty]; 
LTC facilities workers: [Empty]. 

Subgroups of service providers: National Long-Term Care Ombudsman 
Resource Center; 
All types of service providers: [Empty]; 
Legal and law enforcement professionals: [Empty]; 
Medical/health care professionals: [Empty]; 
State/local APS workers: [Empty]; 
State/local LTC providers: [Check]; 
LTC facilities workers: [Empty]. 

Subgroups of service providers: National Institute on Aging (NIA) 
Research Activities Related to Elder Mistreatment; 
All types of service providers: [Check]; 
Legal and law enforcement professionals: [Empty]; 
Medical/health care professionals: [Empty]; 
State/local APS workers: [Empty]; 
State/local LTC providers: [Empty]; 
LTC facilities workers: [Empty]. 

Subgroups of service providers: Interpersonal Violence within Families 
and Among Acquaintances Prevention[A]; 
All types of service providers: [Check]; 
Legal and law enforcement professionals: [Empty]; 
Medical/health care professionals: [Check]; 
State/local APS workers: [Check]; 
State/local LTC providers: [Empty]; 
LTC facilities workers: [Empty]. 

Justice programs: 

Subgroups of service providers: Services, Training, Officers, 
Prosecutors (STOP) Violence Against Women Formula Grant Program; 
All types of service providers: [Check]; 
Legal and law enforcement professionals: [Check]; 
Medical/health care professionals: [Check]; 
State/local APS workers: [Empty]; 
State/local LTC providers: [Empty]; 
LTC facilities workers: [Empty]. 

Subgroups of service providers: Enhanced Training and Services to End 
Violence Against and Abuse of Women Later in Life Program; 
All types of service providers: [Check]; 
Legal and law enforcement professionals: [Check]; 
Medical/health care professionals: [Empty]; 
State/local APS workers: [Empty]; 
State/local LTC providers: [Empty]; 
LTC facilities workers: [Empty]. 

Subgroups of service providers: Coordinated Tribal Assistance 
Solicitations: Tribal Elder Outreach Program; 
All types of service providers: [Check]; 
Legal and law enforcement professionals: [Empty]; 
Medical/health care professionals: [Empty]; 
State/local APS workers: [Empty]; 
State/local LTC providers: [Empty]; 
LTC facilities workers: [Empty]. 

Subgroups of service providers: Grants to Encourage Arrest Policies 
and Enforcement of Protection Orders Program; 
All types of service providers: [Empty]; 
Legal and law enforcement professionals: [Check]; 
Medical/health care professionals: [Empty]; 
State/local APS workers: [Empty]; 
State/local LTC providers: [Empty]; 
LTC facilities workers: [Empty]. 

Subgroups of service providers: Elder Justice and Nursing Home 
Initiative[A]; 
All types of service providers: [Check]; 
Legal and law enforcement professionals: [Check]; 
Medical/health care professionals: [Check]; 
State/local APS workers: [Empty]; 
State/local LTC providers: [Empty]; 
LTC facilities workers: [Empty]. 

Source: GAO analysis of survey data and agency documents. 

[A] These programs did not award grants but rather used funds to 
conduct activities at the federal level and administered contracts and 
interagency agreements as appropriate. In addition to supporting all 
types of service providers, such as providing information and training 
to professionals who work with older adults, these programs targeted 
specific subgroups of service providers, such as medical and health 
care professionals. 

[End of table] 

In addition to serving a range of elder abuse victims and service 
providers, the 12 programs we identified varied with respect to the 
activities they supported, with minimal overlap in some activities 
(see table 4). For example, 4 programs provided victim assistance 
services. Two programs provided support for conducting investigations 
of complaints concerning different members of the older adult 
community, including residents of long-term care facilities and female 
victims in the community. 

Table 4: Variation in Activities Supported by Federal Programs that 
Directed Funds toward Elder Justice: 

Health and Human Services programs: 

Program: Prevention of Elder Abuse, Neglect, and Exploitation[A]; 
Victim assistance services: [Empty]; 
Investigations: [Empty]; 
Law enforcement and prosecution of cases: [Empty]; 
Education, outreach, and information dissemination: [Check]; 
Training and technical assistance: [Check]; 
Advisory services and guidance: [Empty]; 
Information and data management: [Check]; 
Promote state/local coordination: [Check]; 
Developing policies, programs, protocols, and procedures: [Empty]; 
Research: [Check]. 

Program: Long-Term Care (LTC) Ombudsman Program; 
Victim assistance services: [Empty]; 
Investigations: [Check]; 
Law enforcement and prosecution of cases: [Empty]; 
Education, outreach, and information dissemination: [Empty]; 
Training and technical assistance: [Check]; 
Advisory services and guidance: [Check]; 
Information and data management: [Empty]; 
Promote state/local coordination: [Empty]; 
Developing policies, programs, protocols, and procedures: [Empty]; 
Research: [Empty]. 

Program: National Center on Elder Abuse; 
Victim assistance services: [Empty]; 
Investigations: [Empty]; 
Law enforcement and prosecution of cases: [Empty]; 
Education, outreach, and information dissemination: [Check]; 
Training and technical assistance: [Check]; 
Advisory services and guidance: [Check]; 
Information and data management: [Empty]; 
Promote state/local coordination: [Empty]; 
Developing policies, programs, protocols, and procedures: [Empty]; 
Research: [Check]. 

Program: National Adult Protective Services (APS) Resource Center; 
Victim assistance services: [Empty]; 
Investigations: [Empty]; 
Law enforcement and prosecution of cases: [Empty]; 
Education, outreach, and information dissemination: [Check]; 
Training and technical assistance: [Check]; 
Advisory services and guidance: [Empty]; 
Information and data management: [Empty]; 
Promote state/local coordination: [Empty]; 
Developing policies, programs, protocols, and procedures: [Empty]; 
Research: [Check]. 

Program: National Long-Term Care Ombudsman Resource Center; 
Victim assistance services: [Empty]; 
Investigations: [Empty]; 
Law enforcement and prosecution of cases: [Empty]; 
Education, outreach, and information dissemination: [Check]; 
Training and technical assistance: [Check]; 
Advisory services and guidance: [Check]; 
Information and data management: [Empty]; 
Promote state/local coordination: [Check]; 
Developing policies, programs, protocols, and procedures: [Empty]; 
Research: [Empty]. 

Program: National Institute on Aging Research Activities Related to 
Elder Mistreatment; 
Victim assistance services: [Empty]; 
Investigations: [Empty]; 
Law enforcement and prosecution of cases: [Empty]; 
Education, outreach, and information dissemination: [Empty]; 
Training and technical assistance: [Empty]; 
Advisory services and guidance: [Empty]; 
Information and data management: [Empty]; 
Promote state/local coordination: [Empty]; 
Developing policies, programs, protocols, and procedures: [Empty]; 
Research: [Check]. 

Program: Interpersonal Violence within Families and Among 
Acquaintances Prevention[B]; 
Victim assistance services: [Empty]; 
Investigations: [Empty]; 
Law enforcement and prosecution of cases: [Empty]; 
Education, outreach, and information dissemination: [Check]; 
Training and technical assistance: [Check]; 
Advisory services and guidance: [Empty]; 
Information and data management: [Check]; 
Promote state/local coordination: [Empty]; 
Developing policies, programs, protocols, and procedures: [Empty]; 
Research: [Empty]. 

Justice programs: 

Program: Services, Training, Officers, Prosecutors (STOP) Violence 
Against Women Formula Grant Program[A]; 
Victim assistance services: [Check]; 
Investigations: [Check]; 
Law enforcement and prosecution of cases: [Check]; 
Education, outreach, and information dissemination: [Check]; 
Training and technical assistance: [Check]; 
Advisory services and guidance: [Empty]; 
Information and data management: [Check]; 
Promote state/local coordination: [Check]; 
Developing policies, programs, protocols, and procedures: [Check]; 
Research: [Empty]. 

Program: Enhanced Training and Services to End Violence Against and 
Abuse of Women Later in Life Program[A]; 
Victim assistance services: [Check]; 
Investigations: [Empty]; 
Law enforcement and prosecution of cases: [Empty]; 
Education, outreach, and information dissemination: [Check]; 
Training and technical assistance: [Check]; 
Advisory services and guidance: [Empty]; 
Information and data management: [Empty]; 
Promote state/local coordination: [Check]; 
Developing policies, programs, protocols, and procedures: [Empty]; 
Research: [Empty]. 

Program: Coordinated Tribal Assistance Solicitations: Tribal Elder 
Outreach Program[A]; 
Victim assistance services: [Check]; 
Investigations: [Empty]; 
Law enforcement and prosecution of cases: [Empty]; 
Education, outreach, and information dissemination: [Check]; 
Training and technical assistance: [Empty]; 
Advisory services and guidance: [Empty]; 
Information and data management: [Empty]; 
Promote state/local coordination: [Check]; 
Developing policies, programs, protocols, and procedures: [Empty]; 
Research: [Empty]. 

Program: Grants to Encourage Arrest Policies and Enforcement of 
Protection Orders Program[A]; 
Victim assistance services: [Check]; 
Investigations: [Empty]; 
Law enforcement and prosecution of cases: [Empty]; 
Education, outreach, and information dissemination: [Check]; 
Training and technical assistance: [Check]; 
Advisory services and guidance: [Empty]; 
Information and data management: [Check]; 
Promote state/local coordination: [Check]; 
Developing policies, programs, protocols, and procedures: [Check]; 
Research: [Empty]. 

Program: Elder Justice and Nursing Home Initiative[B]; 
Victim assistance services: [Empty]; 
Investigations: [Empty]; 
Law enforcement and prosecution of cases: [Check]; 
Education, outreach, and information dissemination: [Empty]; 
Training and technical assistance: [Check]; 
Advisory services and guidance: [Empty]; 
Information and data management: [Empty]; 
Promote state/local coordination: [Check]; 
Developing policies, programs, protocols, and procedures: [Empty]; 
Research: [Empty]. 

Source: GAO analysis of survey data and agency documents. 

[A] For these programs the granting agency (HHS or Justice) identifies 
a range of activities grantees may conduct, though grantees are not 
required to conduct them all. As a result, some grantees may not 
engage in each of the activities identified here. 

[B] These programs did not award grants but rather used funds to 
conduct activities at the federal level and administered contracts and 
interagency agreements as appropriate. 

[End of table] 

Three broad categories of activity--education, outreach, and 
information dissemination; training and technical assistance to 
service providers; and promoting state and local coordination--were 
supported by most of the 12 programs we identified. While some of 
these activities--education and outreach training for service 
providers, and state and local coordination--appear to overlap, these 
activities were not necessarily providing similar services to similar 
populations. For example, one program supported public education and 
outreach to potential victims to promote financial literacy among 
older adults and prevent financial exploitation. Another program 
trained law enforcement officers to recognize and investigate 
instances of abuse and trained staff in victim services organizations 
and governmental agencies to understand the role each plays in 
addressing elder abuse in the community. A third program promoted 
local coordination among human services organizations, law 
enforcement, and community development programs just within tribal 
communities. Further, some of the grant programs identify several 
allowable activities grantees may conduct using program funds, only a 
few of which may be elder justice-related, but do not require grantees 
to conduct all of them. In one case, the sponsoring agency does not 
track which elder justice projects are funded. For example, in 
describing the department's grant administration practices for the 
STOP Violence program, a Justice official explained that state 
agencies maintain records of the elder justice projects they fund but 
Justice does not. Thus, the number of grantees that conduct elder 
justice activities is not known by Justice. 

When considering, collectively, the variation in the types of funding 
mechanisms and grant recipients, the elder abuse victims and service 
providers targeted by the grants, and the types of activities 
conducted, we found overlap across the 12 programs was minimal. In 
addition, the potentially overlapping activities have been cited as 
being in need of greater federal emphasis, as we will discuss later in 
this report. For example, public awareness and training for 
professionals working with elder abuse victims were two of the areas 
identified by some of the state and local officials we interviewed as 
those in which increased federal support would be beneficial. Also, 
previously discussed, we have recommended that coordination among 
state and local organizations has helped mitigate the effects of 
increasingly limited resources. 

Moreover, the key differences noted above, in conjunction with low 
levels of funding, reduce the risk that two or more area agencies on 
aging or local service providers would be providing the same services 
to the same beneficiaries--that is, that they are providing 
duplicative services. With respect to low funding levels, by the time 
federal elder justice funds are obligated to grantees nationwide, the 
amount of funds available to any individual service provider is likely 
to be low. State officials in all three states we visited said that 
HHS is the primary federal funding source for their elder justice 
activities. Under two HHS programs, the Prevention of Elder Abuse, 
Neglect, and Exploitation program and the Long-Term Care (LTC) 
Ombudsman Program, the federal government distributes funds to state 
aging agencies, which then allocate funds to area agencies on aging or 
local service providers. For example, in fiscal year 2011, of the 
$5,033,000 total obligations for the Prevention of Elder Abuse, 
Neglect and Exploitation program, which directs all funds toward elder 
justice, HHS provided $197,380 to Illinois' state aging agency. The 
allocation to one of the state's 13 area agencies on aging was 
$14,488, which it then distributed to numerous other local service 
providers working directly with older adults, such as county human 
service agencies. In Virginia, HHS provided $118,040 to the state 
aging agency from the Prevention of Elder Abuse, Neglect and 
Exploitation program fiscal year 2011 obligations. According to 
officials at one of Virginia's 25 area agencies on aging, the 
allocation to that agency was $3,027 for that fiscal year. 

Federal Coordination of Elder Justice Activities Is in Development, 
but Monitoring Is Limited: 

Federal Coordination of Elder Justice Activities Is in Development: 

We have previously reported that coordination is key to ensuring the 
efficient use of limited resources to address issues that cut across 
more than one agency.[Footnote 24] With two key federal agencies, HHS 
and Justice, involved in elder justice, and the range of activities 
and individuals served under their programs, coordination may help 
ensure the federal elder justice effort draws on their respective 
expertise and mitigates the effects of fragmentation, as we have also 
reported.[Footnote 25] In addition, we have identified practices that 
can enhance coordination efforts, such as defining and articulating a 
common federal outcome or purpose agencies are seeking to achieve, 
consistent with their respective goals and missions. Developing a 
common federal outcome establishes a rationale for agencies to 
collaborate that helps overcome significant differences in agencies' 
missions, cultures, and established ways of doing business that may 
lead them to work at cross purposes. 

HHS and Justice are involved in developing efforts to coordinate their 
elder justice activities. Most recently, the Elder Justice 
Coordinating Council (Council) was established under the Elder Justice 
Act of 2009 (EJA) to address cross-agency coordination of activities 
relating to elder abuse, neglect, and exploitation.[Footnote 26] 
According to the EJA, the Council should include members representing 
HHS, Justice, and other federal entities with responsibilities or 
programs related to elder abuse. The Council held an inaugural meeting 
in October 2012, where it identified four issue areas for action--
financial exploitation, public policy and awareness, enhancing 
response, and advancing research--and collected white papers from 
issue area experts. The white papers included recommendations for 
improving and advancing the field of elder justice. The Council is 
required to make recommendations to the Secretary of HHS for the 
coordination of elder justice activities by relevant federal agencies 
and report to Congress on accomplishments, challenges, and 
recommendations for legislative action every 2 years. 

The Council met again in May 2013 to consider next steps. The Elder 
Justice Interagency Working Group (Working Group), an informal group 
designed to bring together federal officials responsible for carrying 
out elder justice activities, presented recommendations distilled from 
the white papers.[Footnote 27] The working group's recommendations 
included such actions as launching an elder justice web site, 
developing elder justice forensic centers, a national APS data system, 
a national public awareness campaign, and strategies for combating 
financial exploitation in collaboration with industry. 

The EJA also established an Advisory Board on Elder Abuse, Neglect, 
and Exploitation (Advisory Board), which has a mission, distinct from 
the Council, of developing innovative approaches to improving the 
quality of long-term care, including preventing abuse, neglect, and 
exploitation.[Footnote 28] The Advisory Board is tasked with creating 
short-and long-term strategic plans for the development of the elder 
justice field and making recommendations to the Council. Unlike the 
Council, which is comprised of federal agency officials who administer 
elder justice programs, the Advisory Board will be made up of 
appointed members from the general public with experience and 
expertise in elder abuse, neglect, and exploitation prevention, 
detection, treatment, intervention, and prosecution. Progress so far 
has included a solicitation for nominations for members, issued by HHS 
on July14, 2010.[Footnote 29] 

In addition, HHS and Justice officials from 10 of the 12 elder justice 
programs we identified said they were involved in informal or ad hoc 
coordination efforts with other federal programs. For example, 
officials representing 8 programs reported participating in joint 
program planning and implementation, such as assisting in the review 
of grant solicitations, collecting and sharing materials to support 
elder mistreatment prosecutions, and supporting training initiatives. 
Other coordination efforts program officials reported include 
participating in joint information sessions--such as elder abuse 
awareness events--jointly funding a training initiative, and sharing 
data and information about trends, prevention efforts, and responses 
to abuse, with other agencies or programs. 

Federal Programs Did Not Track Elder Justice Outcomes in 2011: 

While federal agencies have taken steps to better coordinate their 
efforts, less progress has been made in articulating and tracking 
common goals for federal elder justice activities. Program officials 
reported that 4 of the 12 federal programs we identified tracked elder 
justice outcomes in 2011 and one had conducted a program evaluation to 
determine effectiveness. 

We have previously reported that agency-wide strategic planning 
practices required under the Government Performance and Results Act of 
1993 (GPRA)[Footnote 30]--as recently enhanced by the GPRA 
Modernization Act of 2010[Footnote 31]--can also serve as leading 
practices for planning at lower organizational levels, such as 
individual programs or initiatives.[Footnote 32] GPRA provides federal 
agencies with a way to focus on results and improve agency performance 
by, among other things, developing strategic plans. Examples of 
strategic plan components include a mission statement; general goals 
and objectives, including outcome-oriented goals; and a description of 
how the goals and objectives are to be achieved. 

While HHS and Justice, the two agencies that oversee the 12 federal 
elder justice programs we identified, each have defined broad 
strategic goals and objectives at the department level that may impact 
elder justice (see table 5), and ACL has identified a strategic goal 
related to its elder justice responsibilities, the departments have 
not formally defined common goals for addressing concerns of elder 
abuse, neglect, and exploitation. 

Table 5: Strategic Goals and Objectives under HHS and Justice That May 
Address Elder Justice: 

Health and Human Services: 

Department-level strategic goal[A]: 
* Strategic goal 3: Advance the health, safety, and well-being of the 
American people; 
Related objective: 
* Objective 3.C: Improve the accessibility and quality of supportive 
services for people with disabilities and older adults; 
Agency-level goal specific to elder justice[A]: 
* Administration for Community Living strategic goal 4: Ensure the 
rights of older people and prevent their abuse, neglect, and 
exploitation. 

Justice: 

Department-level strategic goal[A]: 
* Strategic goal 2: Prevent crime, protect the rights of the American 
people, and enforce federal law[B]; 
Related objective: 
* Objective 2.2: Prevent and intervene in crimes against vulnerable 
populations; 
uphold the rights of, and improve services to, America's crime victims; 
* Strategic goal 3: Ensure and support the fair, impartial, efficient, 
and transparent administration of justice at the federal, state, 
local, tribal, and international levels; 
Related objective: 
* Objective 3.1: Promote and strengthen relationships and strategies 
for the administration of justice with state, local, tribal, and 
international law enforcement; 
Agency-level goal specific to elder justice[A]: 
* None identified[C]. 

Source: GAO analysis of agency documents. 

[A] For our reporting purposes, "department-level" refers to goals set 
at the level of the Department of Health and Human Services and the 
Department of Justice. "Agency-level" refers to goals set at sub-
department levels, such as the Administration on Aging at HHS or the 
Office on Violence Against Women at Justice. 

[B] Justice's fiscal year 2012 performance and accountability report 
also cites priority goals, intended to represent critical elements of 
the agency's strategic plan, which includes a priority goal to protect 
those most in need of help, such as vulnerable populations including 
the elderly. 

[C] While not defined as a strategic goal, Justice's Office on 
Violence Against Women (OVW) identified a 'priority area' in its 
fiscal year 2013 budget submission to Congress for extending OVW 
programming to underserved communities, including elderly women. 

[End of table] 

Among the 12 federal programs, we determined that 4 tracked outcomes 
for potential victims of elder justice in 2011. 

* HHS's LTC Ombudsman Program reported the number of complaints made 
by residents in long-term care facilities, which include those related 
to elder abuse, neglect, or exploitation, that were resolved to the 
satisfaction of the resident. 

* HHS's NIA Developmental Research on Elder Mistreatment program 
tracked the number of scientific publications resulting from NIA 
funding as a measure of the program's performance in meeting its 
intended purpose of supporting research on elder mistreatment. 

* Justice's Tribal Elder Outreach Program[Footnote 33] monitored 
outcomes related to service delivery for individual grant recipients, 
though these data were not aggregated for the full program. Outcomes 
individual grantees reported included the number of tribal victims 
served as a result of outreach efforts, according to Justice officials. 

* Justice's Abuse in Later Life Program monitored outcomes at the 
grantee level. Outcomes the program tracked included the number of 
professionals trained to respond to domestic violence and sexual 
assault as well as the number of individuals receiving services. 
[Footnote 34] 

For three of the eight programs that did not track elder justice 
outcomes in 2011, officials said they plan to do so in the future. For 
example, officials from two of the programs that directed all funds 
toward elder justice said they plan to develop and monitor outcomes. 
For example, HHS's National APS Resource Center has identified program 
outputs, that will inform the development of outcome measures, such as 
a literature review of evidence-based APS programs and a related 
webinar, which will aim to improve the knowledge-base of participants. 
Similarly, the National Center on Elder Abuse,[Footnote 35] also 
funded by HHS, has identified outcomes such as elder abuse awareness 
and the extent to which research findings are integrated into training 
and practice. 

Similarly, formal evaluation of federal elder justice programs is 
limited. As we have previously reported, researchers designing formal 
evaluations for other programs, including one welfare program, have 
found that they had to fit the evaluation design to available time and 
resources, even when an evaluation is planned for the state rather 
than the federal level.[Footnote 36] For example, in some cases, 
conducting an evaluation for an entire state may be determined to be 
so expensive that data collection has to be limited to a portion of 
the state. Thus, individual program efforts may not always be feasible 
within the resources of many elder justice programs. Nevertheless, one 
program, HHS' NIA research program, held a conference to evaluate the 
progress of research supported by grants awarded to research elder 
justice issues in 2010. Three of the 11 remaining programs also 
indicated they plan to conduct evaluations in the future once more 
work has been completed or if funding becomes available. Officials 
from the other 8 programs reported they have not recently conducted 
nor do they plan to conduct a formal evaluation that includes an 
assessment of elder justice activities. Program officials cited 
several factors that limit their ability to formally evaluate their 
programs, including variability of program activities and scope year 
by year, insufficient data due to a short period of implementation for 
newer programs, and limited resources, including funding devoted to 
and expertise in program evaluation. 

Given the costs associated with evaluating individual programs, 
developing common objectives and outcomes for HHS and Justice elder 
justice programs could be a first step in assessing the federal 
effort. As noted, coordination of these programs is just under way and 
HHS and Justice have not developed common objectives for the elder 
justice effort nor have they defined a set of common outcomes, which 
are necessary precursors to future performance measures, that could be 
used to evaluate the federal effort as a whole. Without progress on 
these fronts, the federal government cannot assess the effectiveness 
of its effort nor the efficient use of resources devoted to elder 
justice activities. 

Challenges Persist in Serving Older Adults and Stakeholders Identified 
a Need for Additional Training and Awareness: 

Officials from the state aging agencies, area agencies on aging, and 
service providers we interviewed identified the increased demand for 
services in a constrained fiscal environment as a major challenge in 
meeting the needs of the growing older adult population. State aging 
agency, area agency on aging, and service provider officials also 
cited the need for greater awareness of elder abuse, by both the 
public and individuals who interact with older adults, to help prevent 
elder abuse or recognize its symptoms. Further, officials in all of 
the state aging agencies we contacted told us that elder abuse cases 
are increasing, especially financial exploitation cases. For example, 
one state official we spoke with said that, as they gave greater 
emphasis to such cases, they found that elder justice cases involving 
financial exploitation, in particular, take longer to investigate, use 
financial records that are difficult to obtain, and are often harder 
to prove than physical or emotional abuse. 

Elder justice activities are a small but important component of the 
broad range of services area agencies on aging (AAA) provided in the 
states we visited. Among these elder justice services were basic legal 
services to older adults, such as assisting with setting up wills, 
power of attorney, or advance directives, which can help deter 
financial exploitation. AAAs we visited also coordinated a number of 
other types of elder justice services. For example, an Arizona AAA 
administers a program funded through a Justice Victims of Crime Act 
grant to provide emergency housing for abused older adults. The same 
AAA uses HHS Title VII of the OAA funding for a Boys and Girls Club 
program to teach young people about respecting older adults. In 
Illinois, a Justice STOP grant helped create the Elder Law and 
Miscellaneous Remedies Division of the Circuit Court of Cook County 
which handles elder abuse cases and other instances where the victim 
is an older adult. 

Officials representing all of the nine AAAs and nine of the local 
providers we interviewed also helped raise awareness of elder abuse 
through education and training programs both for the public in general 
and for those members of the community who regularly interact directly 
with older adults. For example, in Virginia, a local service provider 
received a Justice grant to train criminal justice professional 
service providers, victims, witnesses, and anyone likely to come in 
contact with elders. Such individuals may not be aware of the 
different ways abuse can present itself in the older adult population, 
and other AAA officials said that education and training for these 
direct service providers could help them identify it and respond 
appropriately. The Virginia provider saw its program as helpful in 
determining how to address an abused older adult's problems. In our 
view, in the absence of this awareness, incidents of elder abuse may 
go unreported or unaddressed. 

For the most part, APS agencies in Arizona and Virginia worked with 
AAAs to identify and respond to incidents of elder abuse. Although the 
administrative structure of the AAAs and APS agencies can vary from 
state to state, the basic AAA services can help bolster an older 
adult's independence after an elder abuse incident. Depending on the 
division of responsibility for elder justice services in the state, 
AAAs may refer reports of elder abuse to the state's APS program in 
their area. For example, in Arizona and Virginia, the AAAs turn any 
allegations of elder abuse over to the state APS program upon learning 
about it. However, in Illinois, the state contracts with service 
providers to conduct the entire investigation and disposition of the 
elder abuse cases. Once an investigation has been conducted and 
service needs identified, AAAs may be involved in connecting elder 
abuse victims to services. 

Despite their efforts to raise awareness of elder abuse in their 
communities, officials at five AAAs and four local service providers 
told us that more public awareness and training was needed. Moreover, 
officials from state aging agencies in two of the three states we 
visited said that the federal government should further emphasize the 
need for training law enforcement officers and other officials in 
identifying elder abuse for when they come in contact with older 
adults in need. An AAA official in one of these states said that 
training resources should also be directed to healthcare officials, 
because they are in a position to identify signs of elder abuse. 

In prior work on elder financial exploitation, experts and federal, 
state, and local officials focusing on this form of elder abuse told 
us that older adults need more information about what constitutes 
financial exploitation to know how to avoid it. That prior study found 
that each of the seven federal agencies reviewed independently 
produces and disseminates public information on elder financial 
exploitation that is tailored to its own mission, and worked together 
at times to increase public awareness. For example, each year, the FTC 
and the Postal Inspection Service collaborate on community 
presentations during National Consumer Protection Week. However, 
although the Older Americans Act calls for a coordinated federal elder 
justice system, which includes educating the public, the seven 
agencies reviewed in that prior study did not undertake these 
activities as part of a broader coordinated approach.[Footnote 37] In 
other work on public program effectiveness, we have concluded that 
agencies can use limited funding more efficiently by coordinating 
their activities and can strengthen their collaboration by 
establishing joint strategies.[Footnote 38] 

Of the nine AAA officials we spoke with for this review, five said 
that there is a need for a strategic, national public awareness 
campaign on elder justice, not limited to financial exploitation. 
Officials at three of these AAAs suggested that the federal government 
sponsor a national campaign to raise awareness that would include 
broadly dispersed public education announcements on the prevalence and 
types of elder abuse and helpful resources for those in need. The 
campaign would help service providers and care givers who interact 
with older adults or observe their behavior recognize the signs of 
elder abuse and report it. 

During its meeting in May 2013 to consider next steps, the Elder 
Justice Coordinating Council moved closer to developing a coordinated 
federal effort to prevent and respond to elder abuse. One of the 
actions recommended by the Council's Federal Interagency Working Group 
was the development of a national public awareness campaign. However, 
the Council is currently considering this recommendation and has not 
yet taken a final decision. Our work for this study indicates that 
until a broad-based public awareness campaign is established, many 
incidents of elder abuse may be unreported or unaddressed. 

Conclusions: 

Growth in the percentage of the United States population over 60 years 
of age and in reports of elder abuse may outstrip the public resources 
allocated to serve the elderly. In addition, given the range of elder 
justice activities and individuals served under federal programs, 
coordination is key to ensuring the efficient use of limited 
resources. Further, while federal agencies have taken some initial 
steps toward coordinating their elder justice activities, such as 
forming the Elder Justice Coordinating Council, their efforts to 
develop a coordinated response to elder abuse would be further 
supported by an assessment of the effectiveness of federal elder 
justice programs. Until common objectives and outcomes for federal 
elder justice programs are defined, agencies may be working at cross 
purposes. In addition, with the continuing growth in the older adult 
population, the absence of sufficient public awareness and education 
about elder abuse and the resources available to address it may slow 
the progress of elder justice efforts at all levels of government. 

Recommendations for Executive Action: 

1. To provide the basis for greater consistency across states in 
assessing elder justice service delivery, we recommend that the 
Secretary of HHS, as chairman of the Elder Justice Coordinating 
Council, direct the Council to make it a priority to identify common 
objectives for the federal elder justice effort and define common 
outcomes. 

2. To help protect older adults from all forms of abuse, we recommend 
that the Secretary of HHS and the Attorney General collaborate in 
developing a national campaign to raise awareness of the occurrence of 
elder abuse and provide information on how to obtain services. 

Agency Comments and Our Evaluation: 

We provided a draft of this report to HHS and Justice, the two federal 
agencies that administer the 12 elder justice programs that we 
reviewed. HHS provided general comments that are reproduced in 
appendix III. Both departments provided technical comments, which we 
incorporated as appropriate. 

HHS concurred with our recommendations and agreed that federal 
coordination is key to ensuring the use of limited resources. 
Concerning the first recommendation, HHS identified the formation of 
the Elder Justice Coordinating Council as an effort to develop common 
objectives and plans for action to address elder justice issues. 
Further, HHS said that each of nine proposals for action that the 
Council now is considering has specified outcomes and that steps and 
strategies are being developed to implement the proposals. We agree 
that the Council's activity is indicative of progress toward a 
coordinated federal elder justice effort and development of common 
objectives. We encourage the Council to think broadly in developing 
common objectives and outcomes that will encompass the elder justice 
programs of all federal agencies represented on the Council, both now 
and in the future. HHS said that our recommendations correctly point 
out a need for greater public awareness and, with regard to the second 
recommendation, that one of the proposals for Council action is 
development of a broad-based public awareness campaign. 

HHS also asked us to consider that improved public surveillance could 
help better describe the extent and patterns of abuse among older 
adults. In our previous report on elder abuse,[Footnote 39] 

we noted that, although the 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 40]. In that report, we 
suggest that Congress consider mandating the Secretary of HHS to 
conduct, in coordination with the Attorney General, a periodic 
national study of the extent of elder abuse over time. 

We are sending copies of this report to the appropriate congressional 
committees, the Secretaries of the Departments of Health and Human 
Services and Justice, and other interested parties. We will also make 
copies available to others on request. In addition, the report will be 
available at no charge on GAO's website 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 Office of Congressional Relations and Public 
Affairs can be found on the last page of this report. GAO staff who 
made major contributions to this report are listed in appendix VI. 

Signed by: 

Kay E. Brown: 
Director: 
Education, Workforce, and Income Security Issues: 

[End of section] 

Appendix I: Scope and Methodology for Surveying Federal Elder Justice 
Program Managers: 

This appendix discusses the methodology for surveying federal elder 
justice program managers to gather information for examining the 
potential for fragmentation, overlap, and duplication among federal 
elder justice programs. 

Using lists of existing federal programs, we identified programs 
government-wide that funded elder justice activities, based on program 
selection criteria discussed below. We confirmed the list through 
contact with federal agency officials. We surveyed the federal 
officials who manage the federal elder justice programs on our list, 
and analyzed the programs' similarities and differences with regard to 
key elements, including objectives, activities, funding mechanisms and 
recipients, target populations, outcome measures and fiscal year 2011 
obligations. 

Identification of Federal Elder Justice Programs: 

For the purposes of this study, we defined elder justice as efforts to 
prevent, identify, and respond to elder abuse. To identify federal 
programs that provided funding for elder justice activities in fiscal 
year 2011, we developed an initial list of programs that met our 
definition of elder justice and one of three selection criteria, as 
shown in figure 4. 

Figure 4: Elder Justice Program Selection Criteria: 

[Refer to PDF for image: illustration: stacked inverted pyramid] 

Level 3: A component or allowable activity: 
Program has a broader focus in objectives and target population but 
may conduct activities that relate to elder abuse, neglect, and 
exploitation. 

Level 2: One of multiple objectives: 
Program includes a focus on abuse, neglect, and exploitation for older 
adults, among others. 

Level 1: Primary program objective: 
Program focuses on addressing issues of abuse, neglect, and 
exploitation specifically for older adults. 

Source: GAO methodology. 

[End of figure] 

The list was based on the findings of three prior inventory efforts 
completed by GAO and the Congressional Research Service in 2011, as 
well as searches of the Catalog of Federal Domestic Assistance and 
agency websites. To confirm the programs on our list, we contacted 
agency officials who managed the programs during our entrance 
conferences for additional program information. We also asked agency 
officials to add any programs that we had overlooked in developing the 
list. We then reassessed the list to determine how well the programs 
met the elder justice definition and program selection criteria. 

Survey of Federal Elder Justice Program Managers: 

To determine how federal programs that target elder justice compare 
with respect to key elements, we developed a web-based survey to 
collect descriptive information about programs from agency officials. 
Because program obligations during fiscal year 2011 was one of the 
data elements we needed to collect, the survey was designed to collect 
information from programs that either have elder justice as a primary 
objective or one of multiple objectives. 

To develop the survey questions, we reviewed prior GAO reports on 
elder justice, on serving the aging population, and on identifying 
duplication and overlap in federal programs administered by multiple 
agencies. The survey, modeled after GAO surveys regarding potential 
overlap and duplication, collected information on key program elements 
pertaining to overlap and duplication, including objectives, 
activities, target populations, outcome measures, and obligations 
during fiscal year 2011. The survey was administered between July and 
September 2012. To maximize response, we sent periodic follow-up 
emails to all agency officials that had not responded to the survey by 
our deadline. 

The practical difficulties of conducting any survey may introduce 
several types of errors, commonly referred to as non-sampling errors. 
For example, differences in how a particular question is interpreted, 
the sources of information available to respondents, or the types of 
people who do not respond can introduce unwanted variability into the 
survey results. We included steps in the survey design, data 
collection, and data analysis to minimize such non-sampling errors. In 
designing the survey, we took steps to clarify the survey questions to 
ensure that questions would be correctly interpreted by respondents. 
For example, during its development, we pretested our Web-based survey 
with five selected programs administered by HHS, Justice, and the SEC. 
We conducted these pretests to ensure that the respondents understood 
the questions and could provide the answers to them and the questions 
could be completed in a reasonable amount of time. Following each 
pretest, the survey underwent additional, mostly minor, revisions, 
based on feedback from pretest participants. An additional source of 
non-sampling error can be errors in computer processing of the data 
and statistical analysis. All computer programs relied on for analysis 
of this survey data were independently verified by a second analyst 
for accuracy. 

The survey response rate was 100 percent. In addition to collecting 
program information, the survey allowed us to confirm, exclude, and 
add programs based on consultations with agency officials. As a result 
of our analysis of the survey data, including follow-up contact with 
the agency officials who managed them, we identified 12 programs that 
met one of the first two selection criteria and funded elder justice 
activities in fiscal year 2011. We analyzed whether similarities and 
differences in the 12 programs with respect to key program elements, 
such as sponsoring agency, objectives, activities, target populations 
and grant recipients, indicated potential overlap or duplication, and 
whether program officials could identify program outcomes. 

To augment the survey data, we collected additional information on 
program activities and target groups for individual activities. We 
reviewed program descriptions published on agency websites, in grant 
solicitations, and in budget justifications; and reviewed publicly 
available lists of grant recipients and award amounts. We then grouped 
activity descriptions by type of activity and specific group or 
subpopulation that directly benefited from the activity. For example, 
we determined whether education and outreach efforts were directed at 
the general public or a specific subpopulation of victims of elder 
abuse, such as those in tribal communities. We confirmed these 
classifications with the relevant program officials and added or 
corrected information as necessary. 

[End of section] 

Appendix II: Federal Elder Justice Programs: 

Table 6: Federal Programs That Directed All Funds toward Elder Justice 
(ranked by fiscal year 2011 obligations): 

Department/agency: Justice/OVW; 
Program: Enhanced Training and Services to End Violence Against and 
Abuse of Women Later in Life Program; 
Objective(s) and examples of elder justice activities: Objectives: 
* Enhance the ability of criminal justice professionals, government 
agency staff, and victim assistants to address elder abuse, neglect, 
and exploitation, including domestic violence, dating violence, sexual 
assault, and stalking, in their communities; 
* Develop or enhance a coordinated community response to elder abuse; 
* Provide or enhance services for victims who are 50 years of age or 
older; 
* Conduct cross-training for victim service organizations, 
governmental agencies; criminal justice professionals; 
and nonprofit, nongovernmental organizations serving victims of elder 
abuse, neglect, and exploitation, including sexual assault, domestic 
violence, dating violence, and stalking, in their communities; 
Examples of elder justice activities: 
* Develop multidisciplinary partnerships that include law enforcement, 
prosecutors, domestic violence victim services programs or nonprofits, 
and programs or nonprofits that serve older victims; 
* Training for law enforcement officers, prosecutors, judges, and 
individuals that serve older victims and work in victims services 
programs; 
* Cross training for victim services organizations, governmental 
agencies, courts, law enforcement agencies, and organizations working 
with older victims; 
* Outreach and service delivery to older victims; 
Fiscal year 2011 obligations: $5,249,000[A]. 

Department/agency: HHS/ACL; 
Program: Prevention of Elder Abuse, Neglect, and Exploitation; 
Objective(s) and examples of elder justice activities: Objective: 
* Support activities to develop, strengthen, and carry out programs 
for the prevention, detection, assessment, and treatment of, 
intervention in, investigation of, and response to elder abuse, 
neglect, and exploitation, including financial exploitation.[B]; 
Examples of elder justice activities: 
* Training law enforcement officers, health care providers, and other 
professionals on how to recognize and respond to elder abuse; 
* Support outreach and education campaigns to increase public 
awareness of elder abuse and prevention, including financial 
exploitation; 
* Support efforts of state and local elder abuse prevention coalitions 
and multidisciplinary teams of agencies and organizations that work 
with victims; 
* Promote the development of information and data systems, including 
elder abuse reporting systems, to quantify the extent of elder abuse 
in each state and analyze information to identify unmet service and 
need; 
* Provide technical assistance to programs that provide services for 
victims of elder abuse and their families; 
Fiscal year 2011 obligations: $5,033,000. 

Department/agency: Justice/OJP; 
Program: Coordinated Tribal Assistance Solicitations: Tribal Elder 
Outreach Program; 
Objective(s) and examples of elder justice activities: Objectives: 
* Develop comprehensive outreach strategies and foster improved 
culturally appropriate crime victim assistance services to address 
elder abuse; 
* Augment ongoing crime victim assistance service strategies and 
provide special focus on elders including enhanced collaboration and 
coordination among victim assistance and human services, courts and 
law enforcement, and community development and youth outreach and 
mentoring programs; 
* Link the issue of elder abuse in tribal communities with traditional 
cultural norms of respect and reverence for tribal elders; 
Examples of elder justice activities: 
* Conduct outreach through awareness posters, service brochures, 
editorials and newspaper articles, radio and television ads, videos, 
and fact sheets; 
* Support curriculum development, training, community teaching, and 
awareness efforts; 
* Promote community-based and culturally specific crime victim 
assistance services and develop and distribute related protocols and 
toolkits; 
Fiscal year 2011 obligations: $1,454,000. 

Department/agency: HHS/NIH; 
Program: National Institute on Aging (NIA) Research Activities Related 
to Elder Mistreatment; 
Objective(s) and examples of elder justice activities: Objective: 
* Support research on elder mistreatment and related issues; 
Examples of elder justice activities: 
* Conduct targeted research related to elder mistreatment. Specific 
projects include: 
- Epidemiological study of the relationship of self-neglect and 
important health outcomes in a biracial population of older adults; 
- Study of relevant health issues, including elder mistreatment, in 
older Chinese adults; 
- Development of a mentoring program for aspiring researchers on aging 
topics; 
- Study to determine the extent and outcomes of resident-to-resident 
elder mistreatment in long-term care facilities; 
- Studies of the social and neural bases for older adults' 
vulnerability to financial exploitation; 
Fiscal year 2011 obligations: $1,134,000. 

Department/agency: HHS/ACL; 
Program: National Center on Elder Abuse; 
Objective(s) and examples of elder justice activities: Objective: 
* Provide information, materials, and support to enhance state and 
local efforts to prevent and address elder mistreatment; 
Examples of elder justice activities: 
* Disseminate information about elder abuse prevention, including 
promising practices and interventions, and provide resources to 
professionals and the public; 
* Provide technical assistance, training, and consultation, to state 
agencies and community-based organizations; 
* Advise on program and policy development; 
Fiscal year 2011 obligations: $804,000. 

Department/agency: Justice/Civil Division; 
Program: Elder Justice and Nursing Home Initiative; 
Objective(s) and examples of elder justice activities: Objective: 
* Support and coordinate Justice's activities in combating elder 
abuse, neglect, and financial exploitation, especially as they impact 
beneficiaries of Medicare, Medicaid, and other federal health care 
programs; 
Examples of elder justice activities: 
* Prosecute failure of care, health care fraud, and consumer fraud 
cases and enforce civil rights; 
* Promote state and local coordination through state working groups; 
* Provide training for U.S. Attorney's offices and Medicaid Fraud 
Control Units on investigating and developing failure of care cases; 
* Provide training for nurses, prosecutors, judges, and participants 
of legal aid clinics on fraud and abuse cases; 
Fiscal year 2011 obligations: $747,000[A]. 

Department/agency: HHS/ACL; 
Program: National Adult Protective Services (APS) Resource Center; 
Objective(s) and examples of elder justice activities: Objective: 
* Enhance the quality, consistency, and effectiveness of APS programs 
across the country, with a primary focus on the older population, by 
providing APS systems, agencies, and professionals with relevant 
information and support; 
Examples of elder justice activities: 
* Identify evidence-based practices for APS programs and interventions 
and promote the evaluation of unevaluated practices that have the 
potential to advance and strengthen the efficiency, effectiveness, and 
relevance of APS work; 
* Compile and synthesize research that informs APS programming and 
interventions; 
* Provide specific and targeted technical assistance to state and 
local APS programs to facilitate the implementation of best practices 
and research findings; 
Fiscal year 2011 obligations: 200,000. 

Source: GAO analysis of GAO survey data. 

[A] Reported by agency officials. 

[B] ACL is broadly responsible for federal efforts related to elder 
abuse and prevention services. In addition to administering individual 
programs, ACL is responsible for facilitating the development, 
implementation, and improvement of a coordinated, multidisciplinary 
elder justice system; providing federal leadership to support state 
efforts to carry out elder justice programs; establishing an 
information clearinghouse; and promoting collaborative efforts for the 
development and implementation of elder justice programs. 42 U.S.C. § 
3011(a). 

[End of table] 

Table 7: Federal Programs that Directed Some Funds toward Elder 
Justice (ranked by FY2011 obligations): 

Department/agency: Justice/OVW; 
Program: Services, Training, Officers, and Prosecutors (STOP) Violence 
Against Women Formula Grant Program; 
Objective(s) and examples of elder justice activities: Objectives: 
* Support communities in their efforts to develop and strengthen 
effective law enforcement and prosecution strategies to combat violent 
crimes against women, including older women; 
* Develop and strengthen victim services in cases involving violent 
crimes against women, including older women; 
Examples of elder justice activities: 
* Provide training for law enforcement officers, judges, other court 
personnel, prosecutors, and domestic violence victim service providers 
to more effectively identify and respond to violent crimes against 
women; 
* Develop and implement more effective police, court, and prosecution 
policies and protocols regarding violent crimes against women; 
* Develop data collection and communication systems linking police, 
prosecutors, and courts to identify and track arrests and violations; 
* Support statewide multidisciplinary efforts to coordinate the 
response of state law enforcement agencies, prosecutors, courts, 
victim services agencies, and other state agencies; 
* Provide training for sexual assault forensic medical examiners in 
collecting evidence; 
* Strengthen programs that address violence against older women and 
women with disabilities, including investigating and prosecuting 
instances of violence and targeting outreach, counseling, and other 
victim assistance services; 
Fiscal year 2011 obligations[B]: $136,620,000[B]. 

Department/agency: Justice/OVW; 
Program: Grants to Encourage Arrest Policies and Enforcement of 
Protection Orders Program; 
Objective(s) and examples of elder justice activities: Objectives: 
* Encourage state, local, and tribal governments and courts to treat 
domestic violence, dating violence, sexual assault, and stalking, 
including instances of violence against older individuals, as serious 
violations of criminal law; 
Examples of elder justice activities: 
* Implement pro-arrest programs and policies, including programs that 
train police, prosecutors, and the judiciary in addressing instances 
of abuse; 
* Educate judges in criminal and civil courts about assault, domestic 
violence, dating violence, and stalking; 
* Coordinate computer tracking systems to ensure communication between 
police, prosecutors, parole and probation officers, and criminal and 
family courts; 
* Develop protection order registries and provide technical assistance 
and equipment to law enforcement and legal departments to facilitate 
enforcement of protection orders; 
* Develop methods for identifying the pattern and history of abuse; 
* Establish comprehensive victim service and support centers to 
improve safety, access to services, and confidentiality for victims 
and families; 
Fiscal year 2011 obligations[B]: $44,602,000[A]. 

Department/agency: HHS/CDC; 
Program: Interpersonal Violence within Families and Among 
Acquaintances Prevention; 
Objective(s) and examples of elder justice activities: Objective: 
* Prevent interpersonal violence - including domestic violence, sexual 
assault, spousal and partner abuse, and elder abuse, woman battering, 
and acquaintance rape - within families and among acquaintances; 
Examples of elder justice activities: 
* Develop uniform definitions and recommend data elements for public 
health surveillance of elder abuse and neglect; 
* Provide information and education to the public on interpersonal 
violence to increase awareness of related public health consequences; 
* Provide training to health care providers to identify potential 
victims of interpersonal violence and refer individuals to entities 
that provide supportive services; 
Fiscal year 2011 obligations[B]: $26,634,000[B,C]. 

Department/agency: HHS/ACL; 
Program: Long-Term Care (LTC) Ombudsman Program; 
Objective(s) and examples of elder justice activities: Objectives: 
* Advocate for residents of nursing homes, board and care homes, 
assisted living facilities, and similar adult care facilities and 
improve residents' care and quality of life; 
* Resolve problems of individual residents; 
Examples of elder justice activities: 
* Investigate and resolve complaints made by residents of facilities; 
* Provide training to state and local ombudsmen; 
* Provide consultations to LTC facility managers and staff; 
Fiscal year 2011 obligations[B]: $16,749,000. 

Department/agency: HHS/ACL; 
Program: National Long-Term Care Ombudsman Resource Center; 
Objective(s) and examples of elder justice activities: Objectives: 
* Enhance the skills, knowledge, and management capacity of state LTC 
ombudsman programs to enable them to effectively respond to residents' 
complaints and represent their interests on an individual and systemic 
level; 
* Strengthen the LTC Ombudsman program by developing innovative, 
effective approaches for states to provide services to LTC facility 
residents; 
Examples of elder justice activities: 
* Provide technical assistance to state and local ombudsmen; 
* Provide consultation, information, and referral for ombudsmen, 
residents, and families; 
* Provide training and resources for state and local ombudsman 
programs; 
* Promote public awareness on the role of ombudsmen; 
* Identify research needs and promote research related to ombudsman 
programs and services; 
* Promote cooperation between ombudsman programs and advocacy groups; 
Fiscal year 2011 obligations[B]: $574,000. 

Source: GAO analysis of GAO survey data. 

[A] Amounts reflect spending on all program activities, including 
those unrelated to elder justice, as obligations are not tracked 
separately by activity, according to officials. 

[B] Reported by agency officials. 

[C] The CDC later reported that this amount reflects spending on all 
program activities, including those unrelated to elder justice, as 
obligations are not tracked separately by activity. However, program 
officials estimated that the amount spent on elder justice activities 
in fiscal year 2011 was $50,000. 

[End of table] 

Table 8: Federal Programs with Elder Justice as a Program Component or 
Allowable Activity (Listed by Agency in Alphabetical Order)A: 

Department/agency: Federal Trade Commission (FTC)/Bureau of Consumer 
Protection; 
Program: Consumer Education; 
Objective(s): Educate consumers and businesses about their rights and 
responsibilities, including providing consumers with tools needed to 
make informed decisions and businesses with tools needed to comply 
with law; 
Examples of activities related to elder justice: Provides free 
information to consumers of all ages. The FTC identifies older adults 
as a target population for many of its consumer education efforts, 
including how to recognize and report identity theft and scams/frauds 
related to health care and financial exploitation. 

Department/agency: FTC/Bureau of Consumer Protection; 
Program: Consumer Protection Law Enforcement; 
Objective(s): Enforce consumer protection laws in federal court or 
administrative litigation, especially in cases alleging deceptive 
practices; coordinate joint law enforcement actions with state and 
federal partners, including criminal law enforcement; 
enforce injunctions and administrative orders obtained in consumer 
protection cases; and develop, review, and enforce consumer protection 
rules; 
Examples of activities related to elder justice: The Bureau of 
Consumer Protection has investigated frauds affecting seniors, and 
misrepresentations aimed at the "oldest old" and their caretakers, 
including misrepresentations of services provided when referring 
seniors to long-term care facilities. 

Department/agency: FTC/Bureau of Consumer Protection; 
Program: Consumer Sentinel Network; 
Objective(s): Collect consumer complaint data and share information to 
enable state and local law enforcement to become more effective; 
Examples of activities related to elder justice: Collects and stores 
information on consumer complaints, including financial exploitation 
incidents such as investment fraud and identify theft. Complaints may 
include those reported by older individuals, though the FTC does not 
require complaints to include the age of the victim. 

Department/agency: HHS/Administration for Children and Families (ACF); 
Program: Community Services Block Grant; 
Objective(s): Provide assistance to states, U.S. territories, and 
tribal governments, to provide services and activities to reduce 
poverty; 
Examples of activities related to elder justice: Grants support 
activities that address nutrition, health, and emergency services, 
among others, for low-income individuals including the elderly. 

Department/agency: HHS/ACF; 
Program: Social Services Block Grant; 
Objective(s): Reduce or eliminate dependency; achieve or maintain self-
sufficiency for families; help prevent neglect, abuse, or exploitation 
of children and adults; prevent or reduce inappropriate institutional 
care; and secure admission or referral for institutional care when 
other forms of care are not appropriate; 
Examples of activities related to elder justice: Grants may be used to 
support activities aimed at preventing neglect, abuse, or exploitation 
of children or adults, among others. 

Department/agency: HHS/ACL; 
Program: Home and Community-Based Supportive Services [Supportive 
Services and Senior Centers Program]; 
Objective(s): Provide formula grants to states to support services 
that enable seniors to remain in their homes for as long as possible; 
Examples of activities related to elder justice: Services may include 
case management and legal services, among others. Each state may 
allocate funds to area agencies on aging, which have the flexibility 
to use the funds to provide the services that best meet the needs of 
seniors in their service areas. In providing community services, 
providers could observe and report on potential elder abuse activity. 

Department/agency: HHS/ACL; 
Program: Legal Assistance Developer; 
Objective(s): Promote and enhance state leadership in securing and 
maintaining legal rights of older individuals and state capacity to: 
coordinate the provision of legal assistance, provide technical 
assistance and training; promote financial management services for 
older individuals, assist older individuals in understanding their 
rights, and improve the quality and quantity of legal services 
provided to older adults; 
Examples of activities related to elder justice: The legal assistance 
developer can play a key role in designing and implementing the elder 
rights provisions of state plans to ensure older persons have access 
to their benefits and rights. 

Department/agency: HHS/ACL; 
Program: Legal Assistance-Title III-B Providers; 
Objective(s): Provide assistance for older individuals in accessing 
long-term care options and other community-based services; protect 
older individuals against direct challenges to their independence, 
choice, and financial security; 
Examples of activities related to elder justice: Services are 
specifically targeted to older individuals with economic or social 
needs. Services may include assistance to ensure elder rights 
protections regarding transfers from LTC facilities to home and 
community-based care and assistance for individuals who have 
experienced elder abuse, including consumer fraud and financial 
exploitation. 

Department/agency: HHS/ACL; 
Program: Model Approaches to Statewide Legal Assistance Systems; 
Objective(s): Provide funding to strengthen states' legal services 
networks, including the development and implementation of integrating 
low-cost service mechanisms; 
Examples of activities related to elder justice: Grants support legal 
education and assistance services and may include projects that 
address elder financial exploitation. The program also promotes 
linkages with service providers in area aging agencies, Aging and 
Disability Resource Centers, state long-term care ombudsmen, and APS. 

Department/agency: HHS/ACL; 
Program: National Family Caregiver Support Program; 
Objective(s): Provide grants to states to assist family and informal 
caregivers to care for loved ones at home for as long as possible; 
Examples of activities related to elder justice: Services include 
dissemination of information about services and other assistance 
including counseling and training. 

Department/agency: HHS/ACL; 
Program: National Legal Resource Center; 
Objective(s): Support the aging and legal networks to enhance the 
quality, cost effectiveness, and accessibility of legal assistance and 
elder rights programs; and support demonstration projects to expand or 
improve the delivery of legal assistance and elder rights protections 
to older individuals with social or economic needs; 
Examples of activities related to elder justice: Supported activities 
include case consultation for legal professionals regarding legal 
problems impacting older individuals, training for aging and legal 
services professionals on a range of legal and elder rights issues, 
technical assistance to professionals that provide legal assistance to 
older individuals, and information dissemination regarding legal and 
elder rights issues. 

Department/agency: HHS/ACL; 
Program: Nutrition Services (Congregate Nutrition Services, Home-
Delivered Nutrition Services and Nutrition Services Incentive Program); 
Objective(s): Reduce hunger and food insecurity, promote socialization 
of older individuals, and promote the health and well-being of older 
individuals and delay health conditions through access to nutrition 
and other disease prevention and health promotion services; 
Examples of activities related to elder justice: Grants to states 
support nutrition services including meals and nutrition education. In 
providing or delivering meals, service providers could observe and 
report on potential elder abuse activity. 

Department/agency: HHS/ACL; 
Program: Pension Counseling and Information Program; 
Objective(s): Promote the financial security of older individuals and 
enhance their choice and independence by empowering them to make 
decisions with respect to pensions and savings plans; 
Examples of activities related to elder justice: Projects include 
assisting seniors with the administrative appeals process, locating 
pension plans "lost" as a result of mergers and acquisitions, and 
other assistance in negotiating with former employers for due 
compensation. 

Department/agency: HHS/ACL; 
Program: Resource Centers for Older Indians, Alaskan Natives, and 
Native Hawaiians; 
Objective(s): Provide culturally competent health care, community-
based long-term care, and related services; serve as focal points for 
developing and sharing technical information and expertise for 
organizations, communities, educational institutions, and 
professionals working with older Native Americans; 
Examples of activities related to elder justice: Center activities 
have included assisting in developing community-based solutions to 
improve the quality of life and delivery of support services to the 
Native elderly population and providing a forum for discussions about 
elder abuse to help communities develop plans to reduce and control 
occurrences. 

Department/agency: HHS/ACL; 
Program: Senior Medicare Patrol; 
Objective(s): Empower seniors to protect themselves from the economic 
and health-related consequences of Medicare and Medicaid fraud, error, 
and abuse through increased awareness and understanding of health care 
programs; 
Examples of activities related to elder justice: Activities include 
training Medicare beneficiaries, retired professionals, and other 
senior citizens on how to recognize and report instances or patterns 
of health care fraud and abuse and complaint resolution for 
beneficiaries. 

Department/agency: HHS/Centers for Medicare and Medicaid Services 
(CMS); 
Program: Nationwide Program for National and State Background Checks 
for Direct Patient Access Employees of Long-Term Care (LTC) Facilities 
and Providers; 
Objective(s): Identify efficient, effective, and economical procedures 
for LTC facilities and providers to conduct background checks on a 
statewide basis on all prospective direct patient access employees; 
Examples of activities related to elder justice: States conduct 
background checks to help meet regulations prohibiting LTC facilities 
and providers from employing individuals found guilty of abuse, 
neglect, or misappropriation of patient funds. 

Department/agency: HHS/CMS; 
Program: Office of the Medicare Ombudsman Response to Inquiries and 
Complaints; 
Objective(s): Receive complaints, grievances, and requests for 
information from, and provide assistance to, Medicare beneficiaries; 
Examples of activities related to elder justice: The ombudsman may 
receive inquiries or complaints that mention elder abuse and refer 
complainants to the appropriate agency or organization to address 
their concerns. 

Department/agency: HHS/CMS; 
Program: Survey and Certification of Medicaid and Medicare Providers 
and Suppliers; 
Objective(s): Determine whether service providers and suppliers meet 
applicable requirements for participation in Medicare and/or Medicaid 
programs, and are in compliance with Medicaid and Medicare conditions 
of participation and coverage; 
Examples of activities related to elder justice: Federal and state 
surveyors conduct health and safety inspections in a variety of 
settings, including nursing homes, home health agencies, and 
hospitals, to determine compliance with CMS regulations including 
those that address abuse and neglect of beneficiaries. 

Department/agency: HHS/Health Resources and Services Administration 
(HRSA); 
Program: Comprehensive Geriatric Education Program; 
Objective(s): Train and educate individuals in providing geriatric 
care for the elderly; 
Examples of activities related to elder justice: Activities include 
training, development of curricula related to the treatment of health 
problems of the elderly, continuing education, and establishment of 
traineeships for advanced education students. 

Department/agency: HHS/HRSA; 
Program: Geriatric Academic Career Awards[B]; 
Objective(s): Support the career development of physicians, nurses, 
social workers, psychologists, dentists, pharmacists, and health 
professionals as academic geriatric specialist by requiring them to 
provide training in clinical geriatrics, including the training of 
interdisciplinary teams of health professionals; 
Examples of activities related to elder justice: Faculty teaches and 
develops skills in interdisciplinary education geriatrics. 

Department/agency: HHS/HRSA; 
Program: Geriatric Education Centers[B]; 
Objective(s): Establish or operate Geriatric Education Centers to 
provide interdisciplinary training of health professional faculty, 
students, and practitioners in the diagnosis, treatment and prevention 
of disease, disability, and other health problems of the elderly; 
Examples of activities related to elder justice: Project activities 
include training and continuing education of health professionals in 
geriatrics and developing curricula related to the treatment of health 
problems of the elderly. 

Department/agency: HHS/HRSA; 
Program: Geriatric Training for Physicians, Dentists and 
Behavioral/Mental Health Professionals[B]; 
Objective(s): Provide support, including fellowships, for geriatric 
training projects to train physicians, dentists and behavioral or 
mental health professionals who plan to teach geriatric medicine, 
geriatric dentistry, or geriatric behavioral or mental health; 
Examples of activities related to elder justice: Physicians 
participate in service rotations that include day and home care 
programs, extended care facilities, and community care programs. 

Department/agency: Department of Housing and Urban Development 
(HUD)/Office of Housing; 
Program: Home Equity Conversion Mortgage Program; 
Objective(s): Provide eligible homeowners with education and 
information about the unique features of a reverse mortgage and other 
alternatives to a reverse mortgage that homeowners may consider given 
their financial situation; 
Examples of activities related to elder justice: HUD offers counseling 
to elderly clients who may be at risk of delinquency in paying 
mortgages and may be at risk of becoming victims of financial 
exploitation. 

Department/agency: HUD/Office of Housing; 
Program: Multifamily Housing Service Coordinators; 
Objective(s): Extend the length and improve the quality of independent 
living and prevent premature and inappropriate institutionalization of 
elderly and disabled non-elderly residents of federally-assisted 
multifamily housing; 
Examples of activities related to elder justice: Service coordinators 
assess resident needs; identify and link residents to appropriate 
services in the community, and monitor the delivery of services. 
Service coordinators may also educate residents about other services 
and help them build informal support networks. 

Department/agency: HUD/Office of Public and Indian Housing; 
Program: Resident Opportunities and Self-Sufficiency; 
Objective(s): Link public housing residents with supportive services, 
resident empowerment activities, and assistance in becoming 
economically self-sufficient. For elderly or disabled residents 
specifically, the objective is to help improve living conditions and 
enable residents to age-in-place; 
Examples of activities related to elder justice: Service coordinators 
assess the needs of residents and coordinate available resources, 
including supportive services for elderly residents. 

Department/agency: Justice/Office of Community Oriented Policing 
Services; 
Program: Coordinated Tribal Assistance Solicitations: Tribal Resources 
Grant Program; 
Objective(s): Address the most serious tribal law enforcement needs; 
increase the capacity of tribal law enforcement agencies to prevent, 
solve, and control crime for safer communities; implement or enhance 
community policing strategies; and engage in strategic planning for 
law enforcement; 
Examples of activities related to elder justice: Grants support law 
enforcement training, including community policing and computer and 
crime reporting training. 

Department/agency: Justice/National Institutes of Justice; 
Program: National Institutes of Justice Research, Evaluation, and 
Development Project Grants; 
Objective(s): Encourage and support research, development, and 
evaluation to further understanding of the causes and correlates of 
crime and violence, methods of crime prevention and control, and 
criminal justice system responses to crime and violence; and 
contribute to the improvement of the criminal justice system and its 
responses to crime, violence, and delinquency; 
Examples of activities related to elder justice: Projects include 
research related to elder mistreatment as it relates to the objectives 
of the program, such as identifying the causes and means of preventing 
crime. 

Department/agency: Justice/OVW; 
Program: Coordinated Tribal Assistance Solicitations: Grants to Indian 
Tribal Governments Program; 
Objective(s): Enhance the systemic response to crimes of domestic 
violence, dating violence, sexual assault, and stalking committed 
against American Indian and Alaska Native women and girls; 
Examples of activities related to elder justice: Victim services 
provided under the program, including emergency shelter services, 
crisis intervention, and information and referrals, may be provided to 
older individuals who are victims. 

Department/agency: Securities and Exchange Commission (SEC)/Division 
of Enforcement; 
Program: Enforcement Actions in General Prosecuted by the Division of 
Enforcement; 
Objective(s): Provide investor protection through the prosecution of 
violations of federal of securities laws; 
Examples of activities related to elder justice: Prosecuted cases may 
include those involving older adults as victims. In some instances, 
the elderly were specifically targeted. 

Department/agency: SEC/Division of Enforcement; 
Program: Outreach Activities to Prevent Financial Exploitation of 
Investors; 
Objective(s): Provide information to investors about protecting their 
finances, funds and investments, and ways regulators can support their 
efforts; 
Examples of activities related to elder justice: While most outreach 
activities are targeted at all investors, there are several 
activities, throughout the country, that are specifically focused on 
senior investors, such as Senior Summits, Senior Days and Senior Expos. 

Department/agency: SEC/Division of Trading and Markets; 
Program: Division of Trading and Markets Outreach Activities; 
Objective(s): Engage in outreach activities on an ad hoc basis; 
Examples of activities related to elder justice: Past activities have 
included SEC's Senior Summits which help older investors make 
difficult decisions about their finances and learn new ways to protect 
their assets as they age. 

Department/agency: SEC/Office of Compliance Inspections and 
Examinations; 
Program: Examinations in General Conducted by the Office of Compliance 
Inspections and Examinations; 
Objective(s): Foster compliance with securities laws, detect 
violations, and correct compliance problems by conducting examinations 
of registered entities, broker-dealers, and investment advisers and 
companies, among others; 
Examples of activities related to elder justice: Examinations may 
identify unsuitable transactions for senior investors. 

Department/agency: SEC/Office of Investor Education and Advocacy 
(OIEA); 
Program: Outreach Activities to Inform Investors; 
Objective(s): Provide investors with information needed to evaluate 
current and potential investments, make informed decisions, and avoid 
fraudulent schemes. In addition, provide agency staff with critical 
insight about emerging trends and factors shaping investor decision-
making; 
Examples of activities related to elder justice: OIEA may target 
certain outreach efforts to specific groups, such as seniors, members 
of the military, and teachers. Outreach includes providing resources 
to help individuals become better-educated investors, including 
understanding how to avoid fraud. For example, OIEA continues to 
support the Outsmarting Investment Fraud Campaign, designed to educate 
seniors about identifying potential investment fraud. 

Department/agency: Department of the Treasury/Financial Crimes 
Enforcement Network (FinCEN); 
Program: FinCEN Advisories and Public Education/Outreach Efforts; 
Objective(s): Communicate money laundering or terrorist financing 
risks to the financial industry and facilitate the reporting of 
valuable information to law enforcement; 
Examples of activities related to elder justice: FinCEN issued an 
advisory to financial institutions in 2011 that provided potential 
indicators of elder financial exploitation. 

Source: GAO analysis of agency documentation. 

[A] We surveyed programs with elder justice as a primary objective or 
one of multiple objectives. Programs with elder justice as a program 
component or allowable activity were not within the scope of our 
survey and therefore we did not collect obligations data for these 
programs or verify that obligations were made to these programs in 
fiscal year 2011. We also did not independently verify the agency 
documentation gathered from program officials or agency web sites. 

[B] HHS also refers collectively to these programs--Geriatric Academic 
Career Awards, Geriatric Education Centers, and Geriatric Training for 
Physicians, Dentists and Behavioral/Mental Health Professionals--as 
the Education and Training Relating to Geriatrics program. 

[End of table] 

[End of section] 

Appendix III: Comments from the U.S. Department of Health and Human 
Services: 

Department of Health & Human Services: 
Office of The Secretary
Assistant Secretary for Legislation: 
Washington, DC 20201: 

Kay E. Brown, Director: 
Education, Workforce, and Income Security Issues: 
U.S. Government Accountability Office: 
441 G Street NW: 
Washington, DC 20548: 

Dear Ms. Brown: 

Attached are comments on the U.S. Government Accountability Office's 
(GAO) report entitled, "Elder Justice: More Federal Coordination and 
Public Awareness Needed" (GAO-13-498). 

The Department appreciates the opportunity to review this report prior 
to publication. 

Sincerely, 

Signed by: 

Jim R. Esquea: 
Assistant Secretary for Legislation: 

Attachment: 

General Comments Of The Department Of Health And Human Services (HHS) 
On The Government Accountability Office's (GAO) Draft Report Entitled, 
"Elder Justice: More Federal Coordination And Public Awareness Needed" 
(GAO-13-498): 

The Department appreciates the opportunity to review and comment on 
this draft report. 

The report notes the limited, non-duplicative nature of federal 
programs designed to address the numerous challenges associated with 
identifying, preventing and responding to elder abuse, neglect and 
exploitation at a time when older adults comprise an increasing 
proportion of the nation's population. To address this complicated 
problem, the Elder Justice Act (EJA) of 2009 provides the authority 
for a variety of initiatives needed to better address elder abuse. 
However, funding has not been appropriated to date to implement most 
of the activities contained in the EJA. 

Consistent with this report's recommendation that federal coordination 
is key to ensuring the use of limited resources, the Elder Justice 
Coordinating Council (EJCC) has been convened in order to gather 
together relevant policymakers at the federal level to discuss how to 
develop common objectives and action plans. The EJCC held its 
inaugural meeting in October, 2012, at which time experts provided 
testimony and white papers with recommendations regarding elder 
justice activities and issues. The Elder Justice Working Group (EJWG), 
comprised of staff from the various agencies represented on the EJCC, 
reviewed this input and distilled the recommendations to nine 
proposals. The proposals were presented to the EJCC for consideration 
and input during a May, 2013 meeting. Each of the proposals represents 
a multi-agency, coordinated effort to provide federal leadership in 
addressing the major problems, issues, and gaps presented to the EJCC. 
Work is now underway to develop action steps and strategies for 
implementing these nine proposals, each of which have identified 
outcomes. These action steps will form the basis for a coordinated 
federal agenda, to be presented for consideration to the EJCC this 
fall. Among the nine proposals is one directed at developing and 
implementing a broad-based national public awareness campaign, as 
recommended in this report. 

The proposals include: 

1. Develop a national APS system based upon standardized data 
collection and a core set of service provision standards and best 
practices. 

2. Establish a coordinated research agenda across federal agencies to 
identify best practices for prevention of and intervention in elder 
abuse and elder financial exploitation. 

3. Enhance the ability of frontline professionals and first responders 
to identify diminished capacity broadly, to identify diminished 
financial capacity specifically, and to assess whether an older adult 
has been victimized or is particularly vulnerable to mistreatment. 

4. Prevent, detect and redress elder financial exploitation by 
fiduciaries through improved coordination, oversight and education. 

5. Bolster the ability of financial services providers to prevent, 
detect and respond to elder financial exploitation through guidance to 
industry from government, collaborative efforts, data-sharing, 
research and other strategies. 

6. Develop and implement a broad-based public awareness campaign. 

7. Support the investigation and prosecution of elder abuse, neglect, 
and financial exploitation cases through the creation of a National 
Resource Center for the Investigation and Prosecution of Elder Abuse, 
an Elder Abuse Prosecution Website, and through the creation of a 
successful practices template for the development of additional Elder 
Abuse Forensic Centers. 

8. Support and protect elder victims by enhancing identification of 
and response to elder abuse in all its forms. 

9. Develop training to educate stakeholders across multiple sectors 
and disciplines on preventing, detecting, intervening in, and 
responding to elder abuse, neglect and exploitation. 

Additionally, the National Institute on Aging sponsored a meeting of 
leading experts on elder mistreatment (EM) held at the National 
Academy of Sciences on June 22, 2010. The meeting was called to 
summarize the state-of-the-science in EM, identify gaps in knowledge, 
and elaborate upon the types of work needed to advance the science 
since the National Research Council's 2003 landmark publication Elder 
Mistreatment: Abuse Neglect and Exploitation in an Aging America. 
While NIA's primary interest is to advance research in the field, 
presenters' remarks were wide-ranging including comments on 
infrastructure development, funding, and criminal justice issues. Four 
categories of salient outcomes were noted (emphasis added to those of 
most relevance to NL4): (1) There is a need for interventions at all 
levels of the EM field including prevention, keeping abused elders in 
their own homes, clinical interventions, and legal/criminal justice 
interventions. (2) Measurement issues in EM have developed 
significantly, based upon NIA's funding of methodology development 
grants, and the field is ready to advance to a national 
prevalence/incidence study under the direction of agencies whose 
mission is closely aligned with prevalence/incidence detection such as 
CDC or DOJ. (3) Financial fraud was identified as a significant 
problem with too little research being conducted on determining 
detection and prevention strategies. (4) Finally, more general issues 
such as research involving EM in minority populations, career 
development of researchers in the field, and funding issues related to 
EM were discussed and identified as warranting greater attention and 
investment. 

In response to those identified needs that fall within the NIA mission 
(Recommendations 3 and 4), the NIA will consider the following: 

* Propose to continue to develop NIA research portfolio on financial 
decision making and susceptibility to fraud in older adults, closely 
linked to NIA existing research agenda in understanding the 
psychological and social determinants of healthy aging. 

* Explore the extent to which minority populations are differentially 
or uniquely affected by this kind of elder abuse, and what research is 
needed to examine this issue. 

Lastly, the recommendations correctly point out a need for greater 
public awareness. Please consider that improved public health 
surveillance could help better describe the true extent and patterns 
of abuse and neglect among older adults. 

[End of section] 

Appendix IV: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Kay Brown, (202) 512-7215 or brownke@gao.gov: 

Staff Acknowledgments: 

In addition to the contact listed above, individuals making key 
contributions to this report, in all aspects of the work, were Bill 
Keller, Sara Edmondson, Brenna Guarneros, and Rosemary Torres Lerma. 
Also contributing to the report were James Bennett, Holly Dye, Melissa 
Jaynes, Jill Lacey, Grant Mallie, Amanda Miller, Andrew Nelson, Heddi 
Nieuwsma, and Craig Winslow. 

[End of section] 

Related GAO Products: 

Elder Justice, National Strategy Needed to Effectively Combat Elder 
Financial Exploitation. [hyperlink, 
http://www.gao.gov/products/GAO-13-110]. Washington, D.C.: November 
15, 2012. 

Elder Justice: Stronger Federal Leadership Could Enhance National 
Response to Elder Abuse. [hyperlink, 
http://www.gao.gov/products/GAO-11-208]. Washington, D.C.: March 2, 
2011. 

Older Americans Act: More Should Be Done to Measure the Extent of 
Unmet Need for Services. [hyperlink, 
http://www.gao.gov/products/GAO-11-237]. Washington, D.C.: February 
28, 2011. 

[End of section] 

Footnotes: 

[1] GAO, Elder Justice: Stronger Federal Leadership Could Enhance 
National Response to Elder Abuse, [hyperlink, 
http://www.gao.gov/products/GAO-11-208] (Washington, D.C.: March 2, 
2011) and Elder Justice: National Strategy Needed to Effectively 
Combat Elder Financial Exploitation, [hyperlink, 
http://www.gao.gov/products/GAO-13-110] (Washington, D.C.: Nov. 15, 
2012). 

[2] GAO, 2012 Annual Report: Opportunities to Reduce Duplication, 
Overlap and Fragmentation, Achieve Savings, and Enhance Revenue, 
[hyperlink, http://www.gao.gov/products/GAO-12-342SP] (Washington, 
D.C.: Feb. 28, 2012). 

[3] While there is no standard definition for what constitutes a 
federal program, we defined "program" as an organized set of 
activities supported by a congressional appropriation, allocation, or 
authorization. This can include grants, initiatives, centers, loans, 
funds, and other types of assistance. Further, we defined a program as 
a single program even when its funds were allocated to other programs 
as well, such as a block grant. 

[4] Pub. L. No. 89-73, 79 Stat. 218 (codified as amended at 42 U.S.C. 
§§ 3001-3058ff). 

[5] 42 U.S.C. § 3012(a)(1). 

[6] The OAA uses the term "aging network" (42 U.S.C. § 3002(5)) but we 
found the more descriptive term "aging services network" in widespread 
use. 

[7] Area agencies on aging are sub-state organizations that can 
encompass one or more local governmental jurisdictions, such as cities 
and counties. 

[8] 42 U.S.C. § 3024. 

[9] 42 U.S.C. § 3025(a)(2)(A). 

[10] National Health Policy Forum Background Paper No. 83: The Aging 
Services Network: Serving a Vulnerable and Growing Elderly Population 
in Tough Economic Times, December 13, 2011. 

[11] 42 U.S.C. §§ 1397-1397k-3. 

[12] Pub. L. No.111-148, tit. VI, subtit. H, §§ 6701-6703, 124 Stat. 
119, 782-804 (2010) (codified at 42 U.S.C. §§ 1397j-1397m-5). 

[13] Pub. L. No. 109-432, § 405, 120 Stat. 2922, 3053. 

[14] Pub. L. No. 106-386, sec.1209(a), § 40802, 114 Stat. 1464, 1508 
(codified at 42 U.S.C. § 14041a). 

[15] Pub. L. No. 103-322, tit. IV, 108 Stat. 1796, 1902-1955. 

[16] Pub. L. No. 109-162, § 205, 119 Stat. 2960, 3002 (codified as 
amended at 42 U.S.C. § 14041a). 

[17] Violence Against Women Reauthorization Act of 2013, Pub. L. No. 
113-4, 127 Stat. 54. 

[18] See appendix II, table 9. 

[19] 12 U.S.C. § 5493(g)(3). 

[20] The National Institute on Aging and the National Center on Elder 
Abuse provide funding via federal grants to postsecondary 
institutions. 42 U.S.C. §§ 285e and 3012(d). 

[21] GAO, Results-Oriented Government: Practices that Can Help Enhance 
and Sustain Collaboration among Federal Agencies, [hyperlink, 
http://www.gao.gov/products/GAO-06-15] (Washington, D.C.: Oct. 21, 
2005), and [hyperlink, http://www.gao.gov/products/GAO-12-342SP]. 

[22] See appendix II for more information on 34 programs. 

[23] The three formula grant programs were HHS' Prevention of Elder 
Abuse, Neglect, and Exploitation program (42 U.S.C. § 3058), HHS' Long-
Term Care (LTC) Ombudsman Program (42 U.S.C. § 3058g), and Justice's 
Services, Training, Officer, and Prosecutors (STOP) Violence Against 
Women Formula Grant Program (42 U.S.C. § 3796gg-1). 

[24] GAO, Results-Oriented Government: Practices that Can Help Enhance 
and Sustain Collaboration among Federal Agencies, [hyperlink, 
http://www.gao.gov/products/GAO-06-15] (Washington, D.C.: Oct. 21, 
2005). 

[25] [hyperlink, http://www.gao.gov/products/GAO-06-15]. 

[26] 42 U.S.C. § 1397k. 

[27] Federal agencies participating in the Working Group include HHS, 
Justice, the CFPB, the Social Security Administration, the United 
States Postal Inspection Service, Housing and Urban Development, the 
Department of the Treasury, the Federal Trade Commission, and the 
Securities and Exchange Commission. 

[28] 42 U.S.C.§1397k-1. 

[29] Establishment of the Advisory Board on Elder Abuse, Neglect, and 
Exploitation,75 Fed. Reg. 40,838 (July 14, 2010). 

[30] Pub. L. No. 103-62, § 4(b), 107 Stat. 285, 287 (codified as 
amended at 31 U.S.C. § 1115(a)(1)). 

[31] Pub. L. No. 111-352, § 3, 124 Stat. 3866, 3867-68 (2011) 
(codified at 31 U.S.C. § 1115(a)(1)). 

[32] GAO, Veteran-Owned Small Businesses: Planning and Data System for 
VA's Verification Program Need Improvement, [hyperlink, 
http://www.gao.gov/products/GAO-13-95] (Washington, D.C.: January 14, 
2013). 

[33] 42 U.S.C. § 10603(c)(1). 

[34] 42 U.S.C. § 14041a. 

[35] 42 U.S.C. § 3012(d). 

[36] GAO, Designing Evaluations: 2012 Revision, [hyperlink, 
http://www.gao.gov/products/GAO-12-208G] (Washington, D.C.: Jan. 31, 
2012); and Welfare Reform: Data Available to Assess TANF's Progress, 
[hyperlink, http://www.gao.gov/products/GAO-01-298] (Washington, D.C.: 
Feb. 28, 2001). 

[37] GAO, Elder Justice: National Strategy Needed to Effectively 
Combat Financial Exploitation, [hyperlink, 
http://www.gao.gov/products/GAO-13-110] (Washington, D.C.: Nov. 15, 
2012). 

[38] [hyperlink, http://www.gao.gov/products/GAO-06-15]. 

[39] [hyperlink, http://www.gao.gov/products/GAO-11-208].  

[40] 42 U.S.C. § 3011(e)(2). 

[End of section] 

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