Elder Justice:

Stronger Federal Leadership Could Enhance National Response to Elder Abuse [Reissued on March 22, 2011]

GAO-11-208: Published: Mar 2, 2011. Publicly Released: Mar 2, 2011.

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Each day, news reports cite instances of older adults across the United States being abused, denied needed care, or financially exploited, often by those they depend on. This report contains information on (1) existing estimates of the extent of elder abuse and their quality, (2) factors associated with elder abuse and its impact on victims, (3) characteristics and challenges of state Adult Protective Services (APS) responsible for addressing elder abuse, and (4) federal support and leadership in this area. To obtain this information, GAO reviewed relevant research; visited six states and surveyed state APS programs; analyzed budgetary and other federal documents; reviewed federal laws and regulations; and interviewed federal officials, researchers, and elder abuse experts.

The most recent study of the extent of elder abuse estimated that 14.1 percent of noninstitutionalized older adults had experienced physical, psychological, or sexual abuse; neglect; or financial exploitation in the past year. This study and three other key studies GAO identified likely underestimate the full extent of elder abuse, however. Most did not ask about all types of abuse or include all types of older adults living in the community, such as those with cognitive impairments. In addition, studies in this area cannot be used to track changes in extent over time because they have not measured elder abuse consistently. Based on existing research, various factors appear to place older adults at greater risk of abuse. Physical and cognitive impairments, mental problems, and low social support among victims have been associated with an increased likelihood of elder abuse. Elder abuse has also been associated with negative effects on victims' health and longevity. Although state APS programs vary in their organization and eligibility criteria, they face many of the same challenges. According to program officials, elder abuse caseloads are growing nationwide and cases are increasingly complex and difficult to resolve. However, according to GAO's survey, APS program resources are not keeping pace with these changes. As a result, program officials noted that it is difficult to maintain adequate staffing levels and training. In addition, states indicated they have limited access to information on interventions and practices on how to resolve elder abuse cases, and may struggle to respond to abuse cases appropriately. Many APS programs also face challenges in collecting, maintaining, and reporting statewide case-level administrative data, thereby hampering their ability to track outcomes and assess the effectiveness of services provided. Federal elder justice activities have addressed some APS challenges, but leadership in this area is lacking. Seven agencies within the Departments of Health and Human Services (HHS) and Justice devoted a total of $11.9 million in grants for elder justice activities in fiscal year 2009. These activities have promoted collaboration among APS and its partners, such as law enforcement, but have not offered APS the support it says it needs for resolving elder abuse cases and standardizing the information it reports. Although the Older Americans Act of 1965 has called attention to the importance of federal leadership in the elder justice area, no national policy priorities currently exist. The Administration on Aging in HHS is charged with providing such leadership, but its efforts to do so have been limited. The Elder Justice Act of 2009 authorizes grants to states for their APS programs and provides a vehicle for establishing and implementing national priorities in this area, but does not address national elder abuse incidence studies. The Secretary of HHS should determine the feasibility of providing APS-dedicated guidance, and, in coordination with the Attorney General, facilitate the development and implementation of a nationwide APS data system. Also, Congress should consider requiring HHS to conduct a periodic study to estimate elder abuse's extent. HHS indicated that it will review options for implementing GAO's recommendations.

Matter for Congressional Consideration

  1. Status: Closed - Implemented

    Comments: On September 30, 2012, Sen. Blumenthal introduced the Robert Matava Exploitation Protection for Older Adults Act. Section 102, which addresses data collection, requires the Attorney General, in consultation with the Secretary of Health and Human Services, to annually collect elder abuse incidence data from Federal, State, and local law enforcement agencies and prosecutor offices.

    Matter: The Congress may wish to consider mandating the Secretary of HHS to conduct, in coordination with the Attorney General, a periodic national study of elder abuse's extent to track it over time.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: In September 2011, the Administration on Aging awarded a cooperative agreement to the National Adult Protective Services Association (NAPSA) to establish the first-ever National Adult Protective Services Resource Center. The Center serves as a central source of information and technical assistance for Adult Protective Services (APS) programs and professionals from around the nation. Additional information on the specific activities of the Center is available at their website (http://www.apsnetwork.org/national_resources/aps_resource_center.htm).

    Recommendation: To help APS programs more effectively and efficiently respond to elder abuse, the Secretary of HHS should determine the feasibility and cost of establishing a national resource center for APS-dedicated information that is comprehensive and easily accessible.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: On May 13, 2013, the Secretary of the Department of Health and Human Services convened the Elder Justice Coordinating Council, which includes the Attorney General, among other agency heads. The Council assessed recommendations that had been requested from experts on a range of issues, including a recommendation to develop a national Adult Protective Services (APS) system based upon standardized data collection and modeled after the National Child Abuse and Neglect Data System. Elder Justice Council staff drafted an action plan for this and other recommendations, including identifying current efforts, the agencies that should be involved, and next steps.

    Recommendation: To facilitate the development of a nationwide APS data collection system, the Secretary of HHS should direct AoA to develop a comprehensive long-term plan for implementing such a system within a reasonable amount of time.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Implemented

    Comments: In September 2011, the Administration on Aging began seeking stakeholder input from Adult Protective Services (APS) professionals and others who work in the field of elder abuse prevention and response on what the goals and objectives of a national data collection system should be, and what the challenges and opportunities in developing such a system would be. Efforts to obtain this feedback are ongoing, and the information the Administration on Aging learns will inform future developments in this area.

    Recommendation: To ensure federal and state collaboration in planning and implementing such a system, the Secretary of HHS, in coordination with the Attorney General, should convene a group of state APS representatives to help determine what APS administrative data on elder abuse cases would be most useful for all states and for the federal government to collect; what APS administrative data all states should uniformly collect; and how a system for compiling and disseminating nationwide data should be designed.

    Agency Affected: Department of Health and Human Services

  4. Status: Open

    Comments: In September 2013, the HHS Assistant Secretary for Planning and Evaluation (ASPE) plans to award a contract to take the next step to plan and design a national Adult Protective Services (APS) data system. This project is co-funded by the Administration for Community Living (ACL) and developed in close partnership with the Department of Justice (DoJ). Throughout the project, the federal partners will engage state and local APS leaders, who will use the system both support their programs and to provide information to DoJ and HHS. To identify the requirements of the system, APS stakeholders, federal and state policymakers, law enforcement, and other groups will be convened to identify and come to consensus on the key questions that a national elder abuse data collection system should address. The project will draw upon information collected through a Bureau of Justice Statistics (BJS) project on identifying common state APS data elements and assessing the infrastructure requirements for APS agencies to report data to a national collection system, and to identify a core set of case indicators on which APS agencies should report. The project will use the BJS results (due in April 2014) to identify key functionalities and system specifications, develop a proposed data model and taxonomy, and a "standard" process used to determine the requirements that will drive the design and development of national APS data collection system. This work will help the federal government identify the major considerations for maintaining the system over time, and options for future maintenance and sustainability. At the end of the contract (September 2015), HHS will have a piloted data system, as well as the information it needs to implement the system and begin collecting data from APS agencies.

    Recommendation: To determine the feasibility and cost of collecting uniform, reliable APS administrative data on elder abuse cases from each state, and compiling and disseminating that data nationwide, the Secretary of HHS should, in coordination with the Attorney General, conduct a pilot study to collect, compile, and disseminate these data.

    Agency Affected: Department of Health and Human Services

 

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